CPL Prequalification Form

1

Parent Name* This field is required.

2

Student Name* This field is required.

First Name

Last Name

3

Phone Number* This field is required.

Please enter a valid phone number.

4

Email* This field is required.

example@example.com

5

Will your child be 3 or 4 years old on or before September 1 of the current school year?* This field is required.

Yes, my child will turn 3 years old before September 1 of the current school year.

Yes, my child will turn 4 years old before September 1 of the current school year.

No

6

Check any of the following that apply to your child* This field is required.Select all that apply. These criteria help determine eligibility.

My child is unable to speak and comprehend the English language.

My child is economically disadvantaged.

My child is homeless or was in the conservatorship of the Department of Family and Protective Services (Foster Care).

My child is the child of an active duty member of the armed forces or a member who was injured or killed while serving.

My child is the child of a person eligible for the Star of Texas Award.

None apply

7

Does your family currently receive any of the following?

Family has SNAP

Family has TANF

8

Number of people in the household (All adults and kids)* This field is required.

9

Number of working adults in the home* This field is required.

10

Do the adults work or attend school 25 hours or more per week?* This field is required.

Yes

No

11

Monthly Gross Income (All income before deductions)* This field is required.

12

Upload proof of income

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