NSU University School Mailman Segal Center
Preschool Application Form

Child Information

Child's First Namerequired

Child's Last Namerequired

Gender*

Male Female

Date of Birthrequired (mm/dd/yyyy)

Parent/Legal Guardian Information

Parent 1 First Namerequired

Parent 1 Last Namerequired

Cell Phonerequired

Work Phone

Parent 2 First Name

Parent 2 Last Name

Cell Phone

Work Phone

Mailing Addressrequired

Apartment/Suite

Cityrequired

Staterequired

Ziprequired

Preferred Email Address 1required

Email Address 2

Is either parent/guardian an NSU employee?*

Yes No

If yes, what department(s)?

Do any other children in your family attend NSU University School (preschool-grade 12)?*

Yes No

Please choose the program your child will be participating in for the 2020-21 school year:

NSU University School MSC Preschool Program (PK2-PK4)

Please select the one that applies:

2 years old by December 31 3 years old by September 1 4 years old by September 1

12 Months - Full Year (includes Summer Exploration Camp)

Days

Time

10 Months - School Year

Days

Time

Comments/Additional Information (optional)

Application Fee

Please note there is $50 application fee, which must be sent by mail to the address below. When mailing the fee, be sure to include your child's name and whether you are applying for the PK2, PK3, or PK4 program.

Mailing Address:

NSU University School Mailman Segal Center at the Jim & Jan Moran Family Village
6900 SW 36 Street
Ft. Lauderdale, FL 33314

Once your completed application and payment are received, an admissions representative will get in touch with you. Please be advised that your child's placement is not secured until the application fee is received.

Please send a confirmation email to the address below*:

Please provide an email address where we can send a link to your current form.