Teacher Add/Change Request Form

NC Pre-K Teacher Add/Change Form

Before submitting please upload a copy of the Degree or Transcripts and License or Credential
Effective Date of Change*

MonthDayYear
When possible submit 2 weeks prior to the effective date of change
Site Name*
Name of Teacher Being Replaced:
Classroom Name:
Teacher Name*

First NameMiddle NameLast Name
Maiden Name if Applicable
Email Address*
example@example.com
Years of Experience in NC Pre-K Classroom:*
Years of Experience in Early Childhood:*
NCID # or Work Force ID #*
Is This a Name Change Only?

YesNo
Teacher Type*

LeadLong Term Substitute Lead
Teacher's Race (check all that apply)*

American Indian/Alaska NativeAsianBlack/African AmericanNative Hawaiian/Other Pacific IslanderWhite/Eurpean American
Teacher 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
Date Earned*
Major/Field of Study*
Cumulative GPA 2.70 or Higher?*

YesNo
Relevant Licensure/Credentials (Please upload most current License/Credential)
License/Credential Expiration Date
Please upload a copy of your Degree/Transcripts AND Liscense/Credentials*

Cancelof
EES (Early Educator Support) enrollment is required for teachers employed in a private or head start facility. Which are you?

Public School TeacherPrivate or Head Start Teachers enter the date enrolled in EES
ENROLLMENT TOWARDS DEGREE, LICENSURE, OR CREDENTIALS

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

YesNo
License/Credentials Working Toward:
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
Signature*

Clear
Date*

MonthDayYear
Date
*Refer to NC Pre-K Program Requirements & Guidance for Administrator education, license & credential requirements.
Should be Empty:

NC Pre-K Teacher Add/Change Form

DEGREE, LICENSURE, OR CREDENTIALS*

ENROLLMENT TOWARDS DEGREE, LICENSURE, OR CREDENTIALS