2025-2026 Davey Preschool Family Income/Sliding Tuition Scale Application

DAVEY Preschool Program

DAVEY Preschool Program My child will be receiving intervention services through an IEP and will NOT be a tuition student My child will be a tuition student, I will NOT be applying for a tuition discount My child will be a tuition student, I WILL be applying for a tuition discount
Family Income Form - 2025-2026

Completing the Family Income form is optional. By voluntarily providing family income information, my child may qualify to participate in programs such as The Ben Curtis Foundation's Birdie Bag program.
Family Income Form / Sliding Tuition Scale Application- 2025-2026

The Family Income Form / Sliding Tuition Scale Application is required if applying for a tuition discount. Verification of information provided must be attached to this form in order for it to be considered.
Child's Full Name

Please enter the student's First and Last Name
Child's Date of Birth Child's Date of Birth / MM / DD YYYY
Custodial Parent(s)/Guardian(s) Name(s)

Please enter the First and Last Name of Parent(s)/Guardian(s) living in child's home.
Address Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code
Number of People in Household
Must be a number greater than or equal to 2.
Yearly Income Level for BOTH Household Members

Yearly Income Level for BOTH Household Members $0 - $21,150 $21,151 - $27,495 $27,496 - $31,725 $31,726 - $39,128 $39,129 - $42,300 $42,301 or More
Yearly Income Level for 3 Household Members

Yearly Income Level for 3 Household Members $0 - $26,650 $26,651 - $34,645 $34,646 - $39,975 $39,976 - $49,303 $49,304 - $53,300 $53,301 or More
Yearly Income Level for 4 Household Members

Yearly Income Level for 4 Household Members $0 - $32,150 $32,151 - $41,795 $41,796 - $48,225 $48,226 - $59,478 $59,479 - $64,300 $64,301 or More
Yearly Income Level for 5 Household Members

Yearly Income Level for 5 Household Members $0 - $37,650 $37,651 - $48,945 $48,946 - $56,475 $56,476 - $69,653 $69,654 - $75,300 $75,301 or More
Yearly Income Level for 6 Household Members

Yearly Income Level for 6 Household Members $0 - $43,150 $43,151 - $56,095 $56,096 - $64,725 $64,726 - $79,828 $79,829 - $86,300 $86,301 or More
Yearly Income Level for 7 Household Members

Yearly Income Level for 7 Household Members $0 - $48,650 $48,651 - $63,245 $63,246 - $72,975 $72,976 - $90,003 $90,004 - $97,300 $97,301 or More
Yearly Income Level for 8 Household Members

Yearly Income Level for 8 Household Members $0 - $54,150 $54,151 - $70,395 $70,396 - $81,225 $81,226 - $100,178 $100,179 - $108,300 $108,301 or More
Yearly Income Level for 9 Household Members

Yearly Income Level for 9 Household Members $0 - $59,650 $59,651 - $77,545 $77,546 - $89,475 $89,476 - $110,353 $110,354 - $119,300 $119,301 or More
Yearly Income Level for 10 Household Members

Yearly Income Level for 10 Household Members $0 - $65,150 $65,151 - $84,695 $84,696 - $97,725 $97,726 - $120,528 $120,529 - $130,300 $130,301 or More
Yearly Income Level for 11 or more Household Members

Yearly Income Level for 11 or more Household Members Contact Preschool Office at (330) 676-7415 for Income Levels
Does the child listed above receive FOOD STAMP (SNAP) OR TANF Benefits?

Does the child listed above receive FOOD STAMP (SNAP) OR TANF Benefits? Yes No
Food Stamp (SNAP)/TANF Case Number
Benefit Verification

Benefit Verification I understand this application will not be processed until the preschool office is provided with a SNAP or TANF Certification Notice or letter that verifies the date of certification of SNAP or TANF benefits.
Verification can be uploaded here, emailed to preschool@kentschools.net, faxed to 330-676-7435, dropped off at Davey Preschool during business hours, or mailed to Davey Preschool, 196 N. Prospect St., Kent, OH 44240.

Attach Files
Individual Income

a. Provide monthly amounts received in each category for each household member. Enter "0" if no monthly amounts are received for the member.

b. Foster Child: List the child's monthly personal use income. Enter "0" if the child has no personal use income.
Household Member #1 Household Member #1 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #2 Household Member #2 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #3 Household Member #3 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #4 Household Member #4 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #5 Household Member #5 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #6 Household Member #6 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #7 Household Member #7 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #8 Household Member #8 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #9 Household Member #9 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Member #10 Household Member #10 First Last
Gross Monthly Workplace Earnings (Before Deductions) $ Dollars . Cents
Monthly Government/Public Assistance, Wefare Payments, Child Support, Alimony Received $ Dollars . Cents
Monthly Payments from Pensions, Retirement, Social Security Received $ Dollars . Cents
Any Other Monthly Amounts Received $ Dollars . Cents
Household Members 11+
If there are more than 10 people living in the household, list the first and last name and total monthly amounts received for persons 11 and above.
Example:
11. John Doe -$0.00
12. Jane Doe-$500
Income/Benefit Verification

Income/Benefit Verification I understand this application will not be processed until the preschool office is provided with verification of income/benefits listed above.
Accepted Documentation for Verification Includes:

1. Employment: Most recent W-2 form or five (5) most recent pay stubs.

2. Social Security, Pension, or Retirement: Social Security benefit letter, statement of benefits received, or pension award notice.

3. Unemployment, Disability, or Worker's compensation: Notice of eligibility from State employment security office, check stub, or letter from Worker's Compensation's Office.

4. Child Support or Alimony: Court decree, agreement, or copies of checks received.

5. Other Income (such as rental or scholarship income): Information that shows the amount of income received, how often it is received, and the date received.

Verification can be uploaded here, emailed to preschool@kentschools.net, faxed to 330-676-7435, dropped off at Davey Preschool during business hours, or mailed to Davey Preschool, 196 N. Prospect St., Kent, OH 44240.

Attach Files
Certification and Signature
Certification

Certification I certify that I am the custodial parent/guardian of the child indicated on this form, that all information provided is true and accurate, and that all income and/or benefits have been reported. I understand that this information, unless otherwise authorized, will only be used to determine tuition in the Davey Preschool program under the income eligibility guidelines; that school officials may verify the information on the application; and that deliberate misrepresentation of this information may subject me to prosecution under applicable State and Federal Laws.
Certification

Certification I certify that I am the custodial parent/guardian of the child indicated on this form and that all information provided is true and accurate.
Name of person completing form
Phone Phone - ### - ### ####
Email Address

2025-2026 Davey Preschool Family Income/Sliding Tuition Scale Application

2025-2026 Davey Preschool Family Income/Sliding Tuition Scale Application

Family Income Form - 2025-2026 Completing the Family Income form is optional. By voluntarily providing family income information, my child may qualify to participate in programs such as The Ben Curtis Foundation's Birdie Bag program.

Family Income Form / Sliding Tuition Scale Application- 2025-2026 The Family Income Form / Sliding Tuition Scale Application is required if applying for a tuition discount. Verification of information provided must be attached to this form in order for it to be considered.

Individual Income a. Provide monthly amounts received in each category for each household member. Enter "0" if no monthly amounts are received for the member. b. Foster Child: List the child's monthly personal use income. Enter "0" if the child has no personal use income.

Certification and Signature

Family Income Form - 2025-2026

Completing the Family Income form is optional. By voluntarily providing family income information, my child may qualify to participate in programs such as The Ben Curtis Foundation's Birdie Bag program.

Family Income Form / Sliding Tuition Scale Application- 2025-2026

The Family Income Form / Sliding Tuition Scale Application is required if applying for a tuition discount. Verification of information provided must be attached to this form in order for it to be considered.

Individual Income

a. Provide monthly amounts received in each category for each household member. Enter "0" if no monthly amounts are received for the member.

b. Foster Child: List the child's monthly personal use income. Enter "0" if the child has no personal use income.