2425NCPKApplication-Catawba

2024-2025 Catawba County NC Pre-Kindergarten Application
-Parent Information-

You must complete this application to apply for Catawba County's NC Pre-Kindergarten Program (formerly the More at Four program). Birth date verification (birth certificate) and income verification must be included for the application to be complete. You must use your child's legal name that corresponds with the birth certificate. If you change your address or your phone number, it is your responsibility to let us know so that we have a way to contact you. Please remember to provide accurate information and sign this application, or else it is not complete and can't be considered. While we accept applications throughout the year, you must turn in a completed application by Friday, May 31, 2024, to be considered in the first selection process. Questions? Call Leslie at 828-695-6506 or email NCPK@catawbacountync.gov.

Your application AND all required documentation (birth certification and income verification) must be turned in before your child will be considered for a slot. Your online application will be automatically emailed to the Catawba County Partnership for Children when you submit it. If you have a printed copy of the application you can either:

1) Mail printed application to the Catawba County Partnership for Children,
P.O. Box 3123, Hickory, NC 28603, OR

2) Deliver application to the Partnership for Children Early Childhood Resource Center at 738 4th Street SW in Hickory (Phone: 828-695-6506)

To avoid confusion, please do not turn in your application to any of the NCPK locations. All applications are processed by staff of the Catawba County Partnership for Children.

This is NOT an application for Head Start. For information about Head Start, please call 828-464-1108. For fee payer applications, please contact the preschool department in your school system.

Information about the NC Pre-Kindergarten Program

Age: Must turn 4 by 8/31/2024.

Eligibility Requirements: Based on income; significant priority given to those who have not been in a child care/preschool program before and other factors such as English proficiency, special needs, health needs, etc. Continuity of services for children already receiving support services for special needs will take precedence in site selection. (Information on application will be verified as much as possible to ensure accuracy of issues that relate directly to eligibility.

Transportation: No, transportation is not provided.

Hours: Generally, the same as the site where the classroom is located. Call location for more information. (Some locations may operate on a different schedule.)

Calendar: Same as school calendar.

Fees: No fees for classroom. Families will be assessed separately for the free/reduced lunch program. Depending on eligibility, a fee may be assessed for meals provided at school. All families must complete the school's free/reduced lunch application at the beginning of the school year.

Classroom Structure: Generally, classrooms will have a combination of NCPK children, children with special needs, and fee paying children. All classrooms use "The Creative Curriculum" for Preschool.

Required Documentation: Birth date verification (birth certificate) and income verification (2 pay stubs, tax forms, etc.)

Selection Process: Selection committee meets in mid-June and families will be informed in July.

Before-School and After-School: Call the Children's Resource Center (828-695-6565) for possible locations & other info.

Catawba County's NC Pre-Kindergarten Program
is administered by:

Catawba County Partnership for Children
P.O. Box 3123, Hickory, NC 28603
738 4th Street SW, Hickory, NC 28602
828-695-6505 (phone) 828-328-4551 (fax)
www.catawbakids.com (web)
NCPK@catawbacountync.gov (email)
I have read and understand the NC Pre-K Parent Information above.
2024-2025 Catawba County
NC Pre-Kindergarten Application
Child's First Name:*
Child's Middle Name:
Child's Last Name:*
Child prefers to be called:
Child's Birth Date:*

MonthDayYear
Child must turn 4 by 8/31/24 to qualify
Child's Gender:*

FemaleMale
County
Mother/Guardian's Name
Father/Guardian's Name
Address*

Street Address

Street Address Line 2 / Apt / Unit

CityState

Zip CodeCountry
Email address
example@example.com
Primary Phone*
Additional Phone
If you don't have a phone, can you provide another number where we can reach you?
Please enter a valid phone number.
Is the child Hispanic?

YesNo
Please check all that apply:

AsianBlack or African AmericanNative American or Pacific IslanderNative American or Alaska NativeWhite/European American
Is English spoken in the home?*

Fluent EnglishSome EnglishNo English
What other language(s) does your child speak at home?
When did you move to your current address?*
Please provide month and year
Has your family ever been homeless?*

YesNo
Is your child a United States Citizen? (Citizenship does not affect eligibility for NCPK)

YesNo
What elementary school will your child attend? (If you don't know, write "Don't know.)*
Write "Don't know" if you are unsure.
What is your 1st choice for an NCPK location?*
What is your 2nd choice for an NCPK location?*
What is your 3rd choice for an NCPK location?*
Has anyone in your family ever attended a Head Start or NC Pre-K/More at Four classroom?

YesNo
Who attended, and where did they attend?
FAMILY INFORMATION
Child lives with:*

Both parentsMotherFatherOther
Marital status of parents:*

SingleMarriedSeparatedDivorced
If you have any formal or informal custody arrangements, please let us know:
Are either of the child's parents or legal guardians an active duty member of the armed forces?*

YesNo
Guardian 1 is: (please pick one)

MotherFatherOther
Guardian 1's Date of Birth

MonthDayYear
Date
Guardian 1's employment and school information:

UnemployedEmployed full-timeEmployed part-timeIn school full-timeIn school part-time
Guardian 1's place of employment (if applicable):
Guardian 1's school (if currently enrolled):
Guardian 1's education level:

Has not completed high schoolHas high school diplomaHas GEDHas attended some collegeHas graduated from college
Guardian 2 is: (please pick one)

MotherFatherOther
Guardian 2's Date of Birth

MonthDayYear
Date
Guardian 2's employment and school information:

UnemployedEmployed full-timeEmployed part-timeIn school full-timeIn school part-time
Guardian 2's place of employment (if applicable):
Guardian 2's school (if currently enrolled):
Guardian 2's education level:

Has not completed high schoolHas high school diplomaHas GEDHas attended some collegeHas graduated from college
Please list all other adults living in the household, with relationship to child:
Example: Jane Doe, grandmother
Please list all other children living in the household, age, current school, and grade:
Example: Jacob Doe, 6, 1st grade, Startown
Emergency contact person other than parent (please provide name and relationship to the child):*
Example: John Doe, grandfather
Phone number for emergency contact person:*
Does your child receive any of the following services? (Please check all that apply.)

Speech TherapyPhysical TherapyOccupational TherapyPlay TherapyHome Visits from Early InterventionistEarly Childhood Support Team Clinical SpecialistABA TherapyOther
Has your child been identified with any of the following? (Please check all that apply.)

AutismHearing ImpairedSpeech/Language ImpairedVisually ImpairedOrthopedically ImpairedPreschool Development DelayedOther
If yes, what agency or school system are you working with?
When was the disability identified?
Please provide month and year
Does your child have an Individualized Education Plan (IEP)?

YesNoUnsure
If yes, what school system or agency is the IEP through?

Catawba County SchoolsHickory Public SchoolsNewton-Conover City SchoolsChildren's Developmental Services Agency (CDSA)Other
NC Pre-K and the school systems' exceptional children's programs are separate, but sometimes they can overlap. If your child qualifies for NC Pre-K, we want to work with your family and your school system to find the best possible placement for your child. However, federal, state, and local guidelines regarding exceptional children must take precedence over NC Pre-K guidelines.
Does your child have any chronic health problems?*

YesNo
If yes, please explain your child's health problems:
Does anyone in your immediate family have any special needs, disabilities, or chronic health problems?*

YesNo
If yes, please explain
Is your child currently enrolled in a preschool or child care program?*

YesNo
If yes, which one?
Have you applied for child care subsidy/scholarships through the Department of Social Services?

YesNo
If yes, please check which applies:

We currently receive subsidyWe are on the waiting list for subsidyWe don't qualify for subsidy
If not currently enrolled in child care, has your child ever been enrolled in a child care program?

YesNo
If so, when & where did your child attend?
Who currently takes care of your child during the day?
FINANCIAL INFORMATION
Please pick one:

I have income to report.I do NOT have income to report (additional information may be requested).
Do you get support from any of the following services? (You must check all that apply.)

Food StampsMedicaid/Medicare/Health ChoiceWICPublic Housing AssistanceChild Care Subsidy

Please list amount received from any of the following sources:

	Amount	Frequency (weekly/monthly/annually?)
Child Support Payments
AFDC/Work First
Social Security
Unemployment
Other*

*If you included "Other" above, please list the source:
What is your household's total annual income?*
Do any children in your household qualify for free or reduced lunch at school?*

NoYes - Free LunchYes - Reduced Lunch
Has your family (currently or in the past) received support from Child Protective Services?*

YesNo
Who referred you to the NC Pre-Kindergarten Program?

FamilyNetCDSAChildren's Resource CenterParents as TeachersMental HealthPublic HealthSocial ServicesPublic SchoolsOther
Is there any other information you would like to share with us?
I understand that I will need to submit a copy of my child's birth certificate AND documentation that verifies my family's income. Please check which option you prefer for providing these required documents:*

I will upload the required documents below and understand that this application will not be processed until the required documents are received.I will email the required documents to NCPK@catawbacountync.gov and understand that this application will not be processed until the required documents are received.I will bring the required documents to the Catawba County Partnership for Children at 738 4th Street SW in Hickory (you may drop them in the "Dropbox" outside of our office) OR I will mail the documents to CCPC at P.O. Box 3123, Hickory, NC 28603. I understand that this application will not be processed until the required documents are received.
Birth Certificate - REQUIRED DOCUMENT

Please upload a scanned copy of your child's birth certificate OR email a copy to NCPK@catawbacountync.gov.
Cancelof
Income Verification - REQUIRED DOCUMENT

Please upload documentation that verifies your household income, such as 2 recent check stubs, the front page of your fax form 1040 or your family's W-2 forms. You can also email documentation to NCPK@catawbacountync.gov.
Cancelof
PARENT/GUARDIAN SIGNATURE

I certify that all of the information is true to the best of my knowledge. I understand I am responsible for calling the NCPK Office (828-695-6506) with any changes to information on this application (phone number, address, work status, income, etc.). I give my permission for the information on this application and any other documentation that I submit with this application to be released to the selection committees, the classroom staff, the Division of Child Development and Early Education, and others as necessary. Information on this application will be verified as much as possible to ensure accuracy of issues that relate directly to eligibility. I understand that knowingly providing inaccurate information will result in this application being rejected.
Name of person completing application:*

First NameLast Name
Signature*

Clear
Today's Date*

MonthDayYear
Date
Should be Empty: