Dickenson County Public Schools PreK Application
Please provide the following information to apply for our four-year-old PreK program for the 2026-2027 school year. Within a couple of weeks after your submission, you will receive a PreK Enrollment Packet in the mail to complete and further instructions. You will need to complete all required paperwork and submit all required documents such as; birth certificate, immunization records, and documentation of household income before your child can be acceted into our program and before your child can attend school.
Child's Name
*
First Name
Last Name
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Child's Date of Birth (must be four years old on or before 9-30-2026)
*
-
Month
-
Day
Year
Date
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Parent's Name
*
First Name
Last Name
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
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Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Is your child currently enrolled with Kids Central, Inc?
*
Yes
No
Email
*
example@example.com
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Estimated Yearly Household Income. Include parent(s) gross money income before taxes. Include as income: employment earnings, workers copensation, veterans' benefits payments, survior benefit payments, retirement income, etc. DO NOT include noncash benefits such as SNAP, Medicaid, etc.
*
Number of people living in the household (adults and children)
*
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Indicate if anyone in the household receives any of the following:
TANF
SNAP
SSI
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If your household income is equal to or less than the 130% poverty threshold, your child is eligible to attend the Kids Central Head Start program, and your contact information will be shared with Kids Central. Please check the box below to indicate you have read the statement below.
*
I understand I may be contacted by Kids Central. If I am contaced by Kids Central, I understand I can choose which program is best for my child; Kids Central or Dickenson County Public Schools PreK Program.
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Does your child have a delay or a disability?
*
Yes
No
Did the child's parents earn a high school diploma?
*
Yes
No
Do you currently live with a friend or another family member or in temporary housing?
*
Yes
No
Is the child in foster care?
*
Yes
No
Is either parent currently serving in the military?
*
Yes
No
Is either parent currently incarcerated?
*
Yes
No
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Does the child live in a single parent home?
*
Yes
No
Is the child in care of relatives other than parents?
*
Yes
No
Is there an available affordable daycare option within 10 miles of your home?
*
Yes
No
Is the child potty-trained?
*
Yes
No
Are you concerned about the development of your child?
*
Yes
No
If you have concerns about your child's development, please explain.
Submit
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