Admin Add/Change Request Form

NC Pre-K Admin Add/Change Form

Before submitting please upload a copy of the Degree or Transcripts and License or Credential
1) This form must be submitted to Smart Start Rowan for approval prior to the new Administrator’s first day of employment. Two weeks’ notice is preferable in order to get the appropriate approvals from the NC Pre-K state office.

2) Please upload legible copies of the transcript(s), degree(s), license(s), and resume if applicable. These documents must be included in order for us to enter the Administrator into the NC Pre-K statewide reporting database.
Effective Date of Change

MonthDayYear
When possible submit 2 weeks prior to the effective date of change
Site Name
Title
Principal/Director Name

Principal/Director First NameLast Name
Is this a Principal/Director name change only?
Title
Email Address
example@example.com
Phone
Format: (000) 000-0000.
ext.
Principal/Director's Race (check all that apply)
Principal/Director Ethnicity Hispanic?
DEGREE, LICENSURE, OR CREDENTIALS*

Verification of degree/license REQUIRED, please upload a copy!
Highest Degree Competed (Upload a copy of Degree/Transcripts)
Major/Field of Study
Relevant Licensure/Credentials (Please upload most current License/Credential)

Other, specify:
Please upload a copy of your Degree/Transcripts AND Liscense/Credentials

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ENROLLMENT TOWARDS DEGREE, LICENSURE, OR CREDENTIALS

Please upload supporting enrollment documentation!
Is the Administrator enrolled in a program to obtain additional education?
Licensure/Credentials working towards (Please upload a copy!)

Other, specify:
Degree working towards (Upload a copy of enrollment forms/transcripts)
Major
If working toward a Degree/Licensure/Credentials, please upload supporting documents.

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*Refer to NC Pre-K Program Requirements & Guidance for Administrator education, license & credential requirements.
Signature
Date

MonthDayYear
Date
Should be Empty:

NC Pre-K Admin Add/Change Form

DEGREE, LICENSURE, OR CREDENTIALS*

ENROLLMENT TOWARDS DEGREE, LICENSURE, OR CREDENTIALS