NM Pre-K Program Referral Form
There are no family income restrictions and the program is open to families that have children turning 4 years old by Sept. 1, 2024. Please contact Francesca Duran-Lopez at Francesca@pbjfamilyservices.org for questions or concerns.
Date
-
Month
-
Day
Year
Date
Parent Name
First Name
Last Name
Parent Name
First Name
Last Name
Parent Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Phone Number
Please enter a valid phone number.
Parent Email
example@example.com
Child's Name
First Name
Last Name
Child's Date of Birth (child must be 4 by September 1, 2024)
Which site will your child attend?
South Valley-1101 Lopez Rd SW ABQ, NM 87105 South East-209 San Pablo SE ABQ, NM 87108 Town of Bernalillo-255 A Camino Del Pueblo Bernalillo, NM 87004
Site Preference:
South Valley
South East
Town of Bernalillo
Will you need transportation for your child (limited driving radius)?
Yes
No
Submit
Should be Empty: