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?
Teacher Type
Teacher's Race (check all that apply)
Teacher Ethnicity Hispanic?
DEGREE, LICENSURE, OR CREDENTIALS*

Verification of degree/license REQUIRED, please upload a copy!
Highest Degree Competed (Upload a copy of Degree/Transcripts)
Date Earned
Major/Field of Study
Cumulative GPA 2.70 or Higher?
Relevant Licensure/Credentials (Please upload most current License/Credential)
License/Credential Expiration Date
Please upload a copy of your Degree/Transcripts AND Liscense/Credentials

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

Private 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?
License/Credentials Working Toward:
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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Signature
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