2025-2026 UPK Program Lottery

Child's First Name *

Child's Last Name *

Is your child a twin *

Yes

Twin First Name *

Twin Last Name *

Child's date of birth * +

Primary Guardian's First Name *

Primary Guardian's Last Name *

Primary Phone Number *

Primary Email Address *

Secondary Guardian's First Name *

Secondary Guardian's Last Name *

Secondary Phone Number *

Secondary Email Address *

Complete the information below for where the child you are submitting this form for resides.

Street Address *

Address Line 2

City *

State *

Zip Code *