Apply Online

Thank you for your interest in BELA Preschool and the Backpack Program.
If you are applying for the Backpack Program, please fill out the preschool registration form and select "Backpack Program 2023-2024".
Thank you for expressing interest in BELA preschool.
We are currently accepting registrations for the 2023-2024 school year. Please fill out this application completely and when prompted upload copies of your child's birth certificate, most recent physical, and immunization record. Please, also upload your most recent W-2 or tax return as well as a piece of mail showing your current address.
Please be aware that there is no way to save your application to complete later.
Do not use the back button on your browser once you have submitted your application. It will not allow you to edit the information provided.

Please all of the following questions for the primary adult/guardian.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Email Address (Required)

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Please provide your address. If your mailing is different from your physical address, please provide that information also.

Homelessness is defined as any child or youth who lacks a fixed, regular, and adequate nighttime residence including:
Those who are sharing the housing of other persons due to loss of housing, economic hardship,
Are living in motels, hotels, trailer parks, or camping grounds due to the lack of alternative adequate accommodations;
Are living in emergency or transitional shelters; or are abandoned in hospitals;
Those who have a primary nighttime residence that is a public or private place not designed as a regular sleeping accommodation for human beings;
Those who are living in cars, parks, public spaces, abandoned buildings, substandard housing, bus or train stations, or similar settings;

Is your family experiencing homelessness?

Living Address (Required)

Address Line 2

City (Required)

State (Required)

ZIP (Required)

Click here to find a provider in your area.

Mailing Address same as Living Address

Mailing Address

Address Line 2

City

State

ZIP

Please all of the following questions for the secondary adult/guardian.

Is there another parent/guardian in the family?

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Birthday (Required)

Gender

Email Address

Confirm Email Address

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Mobile Phone

Opt In for Text Messages

Home Phone

Work Phone

Ext.

It appears that you have previously submitted an application. If you wish to apply again, please contact us by phone or in person.

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Highest Grade Completed

Employment Status

Child's Relationship

Custody

Lives with Family

Provides Financial Support

Teen Parent

Are there other adults in the household?

Add Another Adult

Completing the following information gives BELA preschool information about your family to help determine if your child qualifies for a tuition-free preschool slot. Please complete ALL fields.

Number of Parents/Guardians

Relationship to Participant(s)

Primary Language at Home

Is another language being acquired or learned at home?

Number in Family

Gross Annual Income

Is your family receiving cash benefits or other services under the Temporary Assistance for Needy Families (TANF) program?

Is your family receiving Supplemental Security Income (SSI)?

Is your family receiving services from WIC?

Is your family receiving services under the Supplemental Nutrition Assistance Program (SNAP), formerly referred to as Food Stamps?

Is at least one parent/guardian an active duty member of the United States military?

Is at least one parent/guardian a veteran of the United States military?

Please fill out the following information for the child(ren) that you are registering for preschool. If there is more than one child that you would like to register, add them using the "Add Another Applicant" button below.

First Name (Required)

Middle Name

Last Name (Required)

Suffix

Nickname

Birthday (Required)

Gender (Required)

Race

Hispanic

English Proficiency

Other Language

Other Language Proficiency

Primary Health Coverage

Other Coverage

Medicaid Eligibility

Doctor/Medical Home

Dental Coverage

Dentist/Dental Home

Does your child have a disability or do you have any concerns about your child's development?

Is there anything else you want to tell us about your child?

Which program are you applying for? (Required)

Location Preference

1st Location Preference

2nd Location Preference

3rd Location Preference

- Your Address - Available Locations

Click a location on the map to see more info

Click here to find a provider in your area.

Do you want to apply now for another child in your family?

Add Another Applicant

Are there other children in the family?

Add a Sibling

If you are registering for preschool, please follow the additional steps and complete the ASQ 3 screening and Delta County PowerSchool Registration
ASQ-3 Screening
Powerschool Registration
Once everything is complete, please contact Brianna at 970-874-9517 to schedule an interview.

Required information is missing, see above.

Parent/Guardian

Address

Additional Parent/Guardian

Other Adults

Family Information

Child (Applicant)

Location Preferences

Additional Applicant

Siblings