Application for Reverse Inclusion

Children ages 3 and 4 (on September 30) may participate in Early Childhood Special Education classes as “Reverse Inclusion” students and is based upon availability. Applications are only being accepted for students whose neighborhood school is at a location that hosts reverse inclusion or who have a parent who works at that elementary school site.

The determination of participation is based on results from developmental screenings, parent interview, teacher recommendation and parental agreement to the terms of an agreement that outlines the policies of the preschool program administered by Albemarle County Public Schools. * Child's First Name: * Child's Last Name: * Child's Gender: Male Female * Child's date of birth: * The neighborhood public school the child would attend in Kindergarten: * Are you an employee with Albemarle County Public Schools? If "Yes", at which Albemarle County School do you work? * Parent or Guardian's First Name: * Parent or Guardian's Last Name: * Parent or Guardian address where student lives: * Parent or Guardian Mailing Address: * Parent Phone: Parent e-mail address: * Language spoken at home by parents: * Language spoken at home by child: Any comment you would like to make and share: * I understand that this information will only be used to help determine my child’s eligibility for the Albemarle County Preschool Network Programs and will not be released to anyone other than necessary personnel. I certify that the information on this application is true and correct: Yes No