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*

Mr.Mrs.Ms.Dr.
Principal/Director Name*

Principal/Director First NameLast Name
Is this a Principal/Director name change only?

YesNo
Title*

PrincipalInterim PrincipalDirectorInterim Director
Email Address*
example@example.com
Phone*
ext.
Principal/Director's Race (check all that apply)*

American Indian/Alaska NativeAsianBlack/African AmericanNative Hawaiian/Other Pacific IslanderWhite/Eurpean American
Principal/Director Ethnicity Hispanic?*

YesNo
DEGREE, LICENSURE, OR CREDENTIALS*

Verification of degree/license REQUIRED, please upload a copy!
Highest Degree Competed (Upload a copy of Degree/Transcripts)*

Ph.D/Ed.DMA/MSBA/BSAA/ASHigh School Diploma/GED
Major/Field of Study
Relevant Licensure/Credentials (Please upload most current License/Credential)*

Principal LicenseAdmin Credential IIIAdmin Cred IIAdmin Cred IOther, specify:
Please upload a copy of your Degree/Transcripts AND Liscense/Credentials*

Cancelof
ENROLLMENT TOWARDS DEGREE, LICENSURE, OR CREDENTIALS

Please upload supporting enrollment documentation!
Is the Administrator enrolled in a program to obtain additional education?*

YesNo
Licensure/Credentials working towards (Please upload a copy!)

Principal LicenseAdmin Cred IIIAdmin Cred IIAdmin Credential IOther, specify:
Degree working towards (Upload a copy of enrollment forms/transcripts)

Ph.D/Ed.DMA/MSBA/BSAA/AS
Major
If working toward a Degree/Licensure/Credentials, please upload supporting documents.

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

Clear
Date*

MonthDayYear
Date
Should be Empty:

NC Pre-K Admin Add/Change Form

DEGREE, LICENSURE, OR CREDENTIALS*

ENROLLMENT TOWARDS DEGREE, LICENSURE, OR CREDENTIALS