Language
  • English (US)
  • NC Pre-Kindergarten Program 2022-2023 Application

  •  /  /
    Pick a Date
  •  /  /
    Pick a Date
  • Contact Information

  • Mother/Stepmother/Guardian Information

    If the child does not live with mother/stepmother/guardian please select N/A for the following questions. You may enter N/A for the first & last name.
  • Mother's Other Sources of Income

    Please enter the amounts received MONTHLY, for all other sources of income.
  • Father/Stepfather/Guardian Information

    If the child does not live with father/stepfather/guardian please select N/A for the following questions.
  • Father's Other Sources of Income

    Please enter the amounts received MONTHLY, for all other sources of income.
  • List additional children living in the house, under 18 yrs old ONLY:

    If the child applicant is an only child, please skip this section.
  • Child 1: Birthdate:  Relationship to the child applicant:    

  • Child 2: Birthdate:  Relationship to the child applicant:    

  • Child 3: Birthdate:  Relationship to the child applicant:    

  • Child 4: Birthdate:  Relationship to the child applicant:    

  • Adult 1: Relationship to the child applicant: 

  • Adult 2: Relationship to the child applicant: 

  • Adult 3: Relationship to the child applicant: 

  • Adult 4: Relationship to the child applicant: 

  •  /  /
    Pick a Date
  • Additional Information About Your Household

  • Site Selection

    Refer to the FAQ document, on our website, to learn how placement is handled.
  •  
  • Family Information and Responsibilities

  •  
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • Browse Files
    Drag and drop files here
    Choose a file
    Cancel of
  • My signature below is acknowledgement of the following:

    • I am the legal parent/guardian of the child applicant.
    • All of the information on this application is true to the best of my knowledge.
    • I give permission for information regarding my child to be shared between Smart Start Rowan and the school my child may be assigned to and/or the local school system. I understand this information is necessary and will be used for the determination of data analysis, enrollment, eligibility and for educational purposes only.
    • I have read and will comply with the Family Information and Responsibilities.
    • I acknowledge that the application must be signed & dated, all sections completed, and all required documents must be received before my application will be processed & my child considered for placement.
  • Clear
  •  /  /
    Pick a Date
  • Should be Empty: