2025-2026 Caldwell County Preschool Application

1
WELCOME TO PRESCHOOL!/¡BIENVENIDOS AL PREESCOLAR!

We are happy you are applying for NCPK, Head Start, or tuition. Please fully read the information on each page.

Completing the application with take approximately 15-20 minutes. Please reserve enough time to complete the online application in one sitting.

If you prefer to complete a paper version, you will be able to print a copy following this page or you can pick up a copy at your local elementary school, Head Start/Northside Children's Learning Center, A New Beginning Child Care, or at the CCS Preschool Readiness Center, 332 Greenhaven Dr NW, Lenoir.

The first round of placements will occur in May 2025; However, applications are accepted year-round.

Please call us at the Preschool Readiness Center with questions at 828-726-3920.

----------------------------------------------------------------------------------------------

Nos alegra que esté solicitando NCPK, Head Start o matrícula. Lea completamente la información en cada página.

Completar la solicitud tardará aproximadamente entre 15 y 20 minutos. Reserve suficiente tiempo para completar la solicitud en línea de una sola vez.

Si prefiere completar una versión impresa, podrá imprimir una copia siguiendo esta página o puede recoger una copia en su escuela primaria local, Head Start/Northside Children's Learning Center, A New Beginning Child Care, o en el Centro de preparación preescolar de CCS, 332 Greenhaven Dr NW, Lenoir.

La primera ronda de colocaciones se realizará en mayo de 2025; Sin embargo, se aceptan solicitudes durante todo el año.

Si tiene preguntas, llámenos al Centro de preparación preescolar al 828-726-3920.
2
If you have questions, please contact Preschool Readiness Center at 828-726-3920.

There are different options for preschool applications.

Caldwell County Schools Classrooms

Caldwell County Schools preschool applications provide an option for NCPK, private pay tuition, and subsidy vouchers. This electronic application will give you each of these options.

Tuition and Subsidy - Tuition applications are only for school system classrooms. If you are seeking a tuition slot in a private child care center, you must contact that center. This application is not for private centers except for NCPK classrooms at the identified centers.

Jump Start applications are accepted on this app. Jump Start is open to 3 year olds residing in Caldwell County. Children attend 2.5 hours for 2 days each week. There is no cost for Jump Start enrollment.

NC PreK is now available at Hibriten and South Caldwell High Schools.

Head Start at Northside Children's Learning Center

The only Head Start center in Caldwell County is at Northside Children's Learning Center in Lenoir. Our county uses a joint NCPK/Head Start application so parents are only required to complete one application for both. Head Start serves both 3 and 4 year olds. NCPK is only for 4 year olds. Northside also offers Wrap Around care for an additional fee. You must contact Northside directly for more information about Wrap Around.

Private Childcare Sites

NCPK is offered at two additional private childcare sites -- Countryside Childcare in Granite Falls and A New Beginning Child Care in Hudson/Lenoir. Both of these sites offer Wrap Around care for an additional fee. You must contact these centers directly for more information about Wrap Around care.

NCPK Wrap Around

Caldwell County Schools elementary classrooms do not have an option for Wrap Around care. There are four locations (Northside, A New Beginning, South Caldwell High School, and Hibriten High School) do offer Wrap Around care. If you are interested in Wrap Around care, you must contact the individual center and apply separately. Those interested in WrapAround at one of the high schools can contact the Preschool Readiness Center at 828-726-3920.
3
Si tiene preguntas, comuníquese con el Centro de preparación preescolar al 828-726-3920.

Existen diferentes opciones para aplicaciones de preescolar.

Caldwell County Schools Aulas

Caldwell County Schools las solicitudes de preescolar brindan una opción para NCPK, matrícula de pago privado y vales de subsidio. Esta aplicación electrónica le brindará cada una de estas opciones.

Matrícula y subsidio: las solicitudes de matrícula son solo para aulas del sistema escolar. Si está buscando un lugar para la matrícula en un centro de cuidado infantil privado, debe comunicarse con ese centro. Esta solicitud no es para centros privados, excepto para las aulas de NCPK en los centros identificados.

Jump Start Se aceptan solicitudes en esta aplicación. Jump Start está abierto a niños de 3 años que residan en el condado de Caldwell. Los niños asisten 2,5 horas durante 2 días a la semana. La inscripción a Jump Start no tiene ningún costo.

Head Start at Northside Children's Learning Center

El único centro Head Start en el condado de Caldwell está en el Centro de aprendizaje infantil Northside en Lenoir. Nuestro condado utiliza una solicitud conjunta de NCPK/Head Start, por lo que los padres solo deben completar una solicitud para ambos. Head Start atiende a niños de 3 y 4 años. NCPK es sólo para niños de 4 años. Northside también ofrece atención Wrap Around por una tarifa adicional. Debe comunicarse directamente con Northside para obtener más información sobre Wrap Around.

Sitios privados de cuidado infantil

NCPK se ofrece en dos sitios de cuidado infantil privados adicionales: Countryside Childcare en Granite Falls y A New Beginning Child Care en Hudson/Lenoir. Ambos sitios ofrecen atención Wrap Around por una tarifa adicional. Debe comunicarse directamente con estos centros para obtener más información sobre la atención Wrap Around.

NCPK Wrap Around

Las aulas de primaria de las Escuelas del Condado de Caldwell no ofrecen la opción de cuidado infantil integral. Cuatro centros (Northside, A New Beginning, South Caldwell High School y Hibriten High School) sí ofrecen este servicio. Si le interesa, debe contactar a cada centro y solicitarlo por separado. Quienes estén interesados en el programa WrapAround en alguna de las escuelas secundarias pueden comunicarse con el Centro de Preparación Preescolar al 828-726-3920.
4
I prefer to complete the application by/Prefiero completar la solicitud por* This field is required.
continuing the online application/continuar con la solicitud en línea
printing a paper copy of the application/imprimir una copia en papel de la solicitud
5
Do you want to complete the online application?/¿Quieres completar la solicitud en línea?Selecting NO will return you to select a paper application to print./Al seleccionar NO, volverá a seleccionar una solicitud en papel para imprimir.
YESNO
6
Please select which paper application you would like to print./Seleccione qué solicitud en papel desea imprimir.
NCPK/Head Start - English
NCPK/Head Start - Spanish
Caldwell Schools Tuition: Elementary
Caldwell Schools Tuition: High School
Jump Start - English
Jump Start - Spanish
7
English: You may print the NCPK/Head Start paper application here.Click Next for Spanish. Click Next for tuition application.
8
NCPK: Do you want to print a different paper application?
Yes
No
9
Spanish: Puede imprimir la solicitud impresa de NCPK/Head Start aquí.Haga clic en NEXT para la solicitud de matrícula.
10
Spanish NCPK: ¿Quieres imprimir una solicitud en papel diferente?
Yes
No
11
You may print the tuition application for Caldwell County Schools Elementary Preschool classrooms here.You may also elect to complete this application via this electronic app.
12
Elementary Tuition: Do you want to print a different paper application?/Matrícula de primaria: ¿Quiere imprimir una solicitud en papel diferente?
Yes
No
13
If you have questions, please contact Preschool Readiness Center at 828-726-3920.

There are different options for preschool applications.

Caldwell County Schools Classrooms

Caldwell County Schools preschool applications provide an option for NCPK, private pay tuition, and subsidy vouchers. This electronic application will give you each of these options.

Tuition and Subsidy - Tuition applications are only for school system classrooms. If you are seeking a tuition slot in a private child care center, you must contact that center. This application is not for private centers except for NCPK classrooms at the identified centers.

Jump Start applications are accepted on this app. Jump Start is open to 3 year olds residing in Caldwell County. Children attend 2.5 hours for 2 days each week. There is no cost for Jump Start enrollment.

NC PreK is now available at Hibriten and South Caldwell High Schools.

Head Start at Northside Children's Learning Center

The only Head Start center in Caldwell County is at Northside Children's Learning Center in Lenoir. Our county uses a joint NCPK/Head Start application so parents are only required to complete one application for both. Head Start serves both 3 and 4 year olds. NCPK is only for 4 year olds. Northside also offers Wrap Around care for an additional fee. You must contact Northside directly for more information about Wrap Around.

Private Childcare Sites

NCPK is offered at two additional private childcare sites -- Countryside Childcare in Granite Falls and A New Beginning Child Care in Hudson/Lenoir. Both of these sites offer Wrap Around care for an additional fee. You must contact these centers directly for more information about Wrap Around care.

NCPK Wrap Around

Caldwell County Schools elementary classrooms do not have an option for Wrap Around care. There are four locations (Northside, A New Beginning, South Caldwell High School, and Hibriten High School) do offer Wrap Around care. If you are interested in Wrap Around care, you must contact the individual center and apply separately. Those interested in WrapAround at one of the high schools can contact the Preschool Readiness Center at 828-726-3920.
14
Tuition Application for High School Learning Lab programs (paper only, not available as part of the electronic application at this time)Please note that High School Early Learning Labs are open for a longer day than elementary classrooms.
15
High School: Do you want to print a different paper application?/Escuela secundaria: ¿Quieres imprimir una solicitud en papel diferente?
Yes
No
16
Jump Start Application - EnglishJump Start is for 3 year olds and is free to all Caldwell County residents.
17
Jump Start: Do you want to print a different paper application?
Yes
No
18
Jump Start Application - SpanishJump Start is for 3 year olds and is free to all Caldwell County residents.
19
Spanish Jump Start: ¿Quieres imprimir una solicitud en papel diferente?
Yes/Si
No
20
You are completing this application on
Date
Month
Day
Year
21
How old will your child be on August 31, 2025?/¿Qué edad tendrá su hijo el 31 de agosto de 2025?* This field is required.This application is used for determining eligibility for both Head Start (3 and 4 year old) and NCPK (4 year old only). Those applying for tuition slots and Jump Start with Caldwell County Schools should also proceed with this electronic application./Esta solicitud se utiliza para determinar la elegibilidad tanto para Head Start (niños de 3 y 4 años) como para NCPK (solo para niños de 4 años). Aquellos que soliciten plazas de matrícula y Jump Start con las escuelas del condado de Caldwell también deben continuar con esta solicitud electrónica.
Head Start 3 years old: Your child may be eligible for Head Start, but is not yet old enough for NCPK./3 años: su hijo puede ser elegible para Head Start, pero aún no tiene la edad suficiente para NCPK
Jump Start 3 years old: Check this box if you are interested in the Jump Start program. Jump Start is free of charge to Caldwell residents. Children attend 2, half-days per week/3 años: marque esta casilla si está interesado en el programa Jump Start. Jump Start es gratuito para los residentes de Caldwell. Los niños asisten 2 medias jornadas por semana.
NCPK/Head Start 4 years old: Your child may be eligible for Head Start and/or NCPK/4 años: su hijo puede ser elegible para Head Start y/o NCPK
Tuition 3 or 4 years old: Caldwell County Schools tuition applications. Check this box if you are ONLY applying for a tuition slot at an elementary or high school. CCS also accepts NC subsidy vouchers./ 3 o 4 años: solicitudes de matrícula de las escuelas del condado de Caldwell. Marque esta casilla si SOLO está solicitando un cupo de matrícula en una escuela primaria o secundaria. CCS también acepta vales de subsidio de Carolina del Norte.
22
Required Documents to Complete Application: CCS Tuition and JumpStart Applications/Documentos requeridos para completar la solicitud: Solicitudes de matrícula CCS y JumpStartThis list of documentation is due before school starts for all children under a tuition or JumpStart slot with Caldwell County Schools. You will have an option to upload documents at the end of the application. If you elect not to upload documents, you may submit them via email, fax, or drop off. Details will be at the end of the application./Esta lista de documentación debe entregarse antes de que comiencen las clases para todos los niños con matrícula o cupo JumpStart en las Escuelas del Condado de Caldwell. Tendrá la opción de cargar documentos al final de la solicitud. Si elige no cargar documentos, puede enviarlos por correo electrónico, fax o entregarlos. Los detalles estarán al final de la solicitud.
Copy of Child's Birth Certification/Copia del Certificado de Nacimiento del Niño
Copy of Legal Guardianship/Custody Paper, if applicable/Copia del documento de tutela/custodia legal, si corresponde
Health Transmittal Form and Dental Form (Completed on or after September 2, 2024)/Formulario de transmisión de salud y formulario dental (completado a partir del 2 de septiembre de 2024)
Up to Date Immunization/Shot Record/Registro de vacunas/vacunas actualizado
23
CCS High School Early Learning Labs

***NC PreK slots are now open at both Hibriten and South Caldwell High Schools. If interested, you may apply using the NCPK application option.

CCS Early Learning Labs are located on high school campuses (Hibriten and South Caldwell). These classrooms meet the same requirements for staff qualifications and student instruction. The differences between high school preschools and elementary preschools is the length of day and student opportunities.

Early Learning Labs are open 7:15 am to 4:15 pm to allow for a longer day for working parents. During the day, our preschool students have high school student interns who are taking classes to learn about child development, parenting, and teaching. We also collaborate with clubs who perform community service.

In addition to a longer student day, Early Learning Labs are open on Optional Planning and Planning days. Parents who wish for their child to attend on those days can pay an additional daily fee.

-----------------------------------------------------------------------------------------------

Laboratorios de aprendizaje temprano de la escuela secundaria CCS

Los laboratorios de aprendizaje temprano de CCS están ubicados en los campus de las escuelas secundarias (Hibriten y South Caldwell). Si bien no son aulas del NCPD, las aulas cumplen con los mismos requisitos de calificaciones del personal y de instrucción de los estudiantes. Las diferencias entre los preescolares de secundaria y los preescolares de primaria son la duración del día y las oportunidades para los estudiantes.

Los laboratorios de aprendizaje temprano están abiertos de 7:15 am a 4:15 pm para permitir un día más largo para los padres que trabajan. Durante el día, nuestros estudiantes de preescolar tienen estudiantes en prácticas de secundaria que toman clases para aprender sobre el desarrollo infantil, la paternidad y la enseñanza. También colaboramos con clubes que realizan servicio comunitario.

Además de una jornada estudiantil más larga, los laboratorios de aprendizaje temprano están abiertos los días de planificación y planificación opcionales. Los padres que deseen que su hijo asista esos días pueden pagar una tarifa diaria adicional.
24
Required Documents to Complete Application for NCPK & Head Start/Documentos requeridos para completar la solicitudThis is a list of the documentation required for your application to be processed. This list is for your information. You will have the option to upload these documents at the end of the online application. If you elect not to upload documents, you may submit them via email, fax, or drop off. Details will be at the end of the application./Esta es una lista de la documentación requerida para que se procese su solicitud. Esta lista es para su información. Tendrá la opción de cargar estos documentos al final de la solicitud en línea. Si elige no cargar documentos, puede enviarlos por correo electrónico, fax o entregarlos. Los detalles estarán al final de la solicitud.
25
Child Information* This field is required.Please complete all information for the preschool child you are applying for. Twins will need a separate application completed.
26
Child's Date of Birth/Fecha de nacimiento del niño* This field is required.
27
If accepted into the program, my child would require before/after school care? I will contact one of the community sites to make arrangements./Si es aceptado en el programa, ¿mi hijo necesitaría cuidado antes o después de la escuela? Me comunicaré con uno de los sitios de la comunidad para hacer arreglos.* This field is required.Caldwell County Schools does not currently have before/after school care for the preschool program. Community sites that do have this option are A New Beginning Childcare, Countryside Child Care, and Northside Children's Learning Center./Las Escuelas del Condado de Caldwell actualmente no cuentan con cuidado antes y después de la escuela para el programa preescolar. Los sitios comunitarios que sí tienen esta opción son A New Beginning Childcare, Countryside Child Care y Northside Children's Learning Center.
YESNO
28
If accepted into the program, I will provide transportation or have other arrangements made./Si soy aceptado en el programa, proporcionaré transporte o haré otros arreglos.* This field is required.Prompt pickup in the afternoon is an expectation of the program. Late pickup will result in fees. Chronic late pickup may result in ejection from the program./La pronta recogida por la tarde es una expectativa del programa. La recogida tardía dará lugar a cargos. La recogida tardía crónica puede resultar en la expulsión del programa.
YESNO
29
If accepted into the program, I understand that timely arrival and departure are my responsibility. Initials/Si soy aceptado en el programa, entiendo que la llegada y salida puntuales son mi responsabilidad. Iniciales* This field is required.
30
Child's Gender/Género del niño* This field is required.
Boy/Chico
Girl/Chica
31
Is your child Hispanic/Es tu hijo hispano* This field is required.
YESNO
32
County of Residence/Condado de residencia* This field is required.If Other, please enter the county of residence./Si es Otro, ingrese el condado de residencia.
Caldwell
Burke
Catawba
Other
33
You have selected a county of residence that is not Caldwell County. You may still apply for Caldwell County preschool slots; However, priority is given to residents of Caldwell. If you have questions, please feel free to contact the Preschool Readiness Center at 828-726-3920

------------------------------------------------------------------------------------------------

Ha seleccionado un condado de residencia que no es el condado de Caldwell. Aún puede solicitar plazas para preescolar del condado de Caldwell; Sin embargo, se da prioridad a los residentes de Caldwell. Si tiene preguntas, no dude en comunicarse con el Centro de preparación preescolar al 828-726-3920.
34
What elementary school is your zoned school district (assigned)?/¿Qué escuela primaria es su distrito escolar zonal (asignada)?* This field is required.
Baton
Collettsville
Davenport
Dudley Shoals
Gamewell
Granite Falls
Happy Valley
Hudson
King Creek
Lower Creek
Sawmills
Valmead
Whitnel
I do not know my elementary school district/No conozco mi distrito de escuela primaria
I do not live in Caldwell County./No vivo en el condado de Caldwell.
35
Race (check all that apply)/Raza (marque todo lo que corresponda)* This field is required.If Other is selected, please explain./Si se selecciona Otro, explique.
White
Black
Native American/Alaskan
Bi-Racial
Asian
Native Hawaiian/Pacific Islander
Other
36
Is your child a NC resident?/¿Es su hijo residente de Carolina del Norte?* This field is required.
YESNO
37
Is your child a US citizen?/¿Es su hijo ciudadano estadounidense?* This field is required.
YESNO
38
What language does your child most frequently use to communicate?/¿Qué idioma utiliza su hijo con más frecuencia para comunicarse?* This field is required.
Arabic/árabe
Chinese/Chino
English/Inglés
Spanish/Español
Vietnamese/Hmong/vietnamita/hmong
Other
39
What language(s) are frequently used in home?* This field is required.Select all that apply. If Other is selected, please explain.
Arabic/árabe
Chinese/Chino
English/Inglés
Spanish/Español
Vietnamese/vietnamita
Vietnamese/Hmong/vietnamita/hmong
Other
40
Child/family is currently being served by Child Protective Services/El niño/la familia actualmente está siendo atendido por los Servicios de Protección Infantil.* This field is required.
No
Yes, Currently in Foster Care/Sí, actualmente en cuidado de crianza
Yes, Currently resides with parent(s)/Sí, actualmente reside con los padres.
I am caring for a child who is awaiting foster care placement/Estoy cuidando a un niño que está esperando ser colocado en cuidado de crianza
41
Please select all that apply to your child's current family status:/Seleccione todo lo que corresponda al estado familiar actual de su hijo:* This field is required.
WIC
Food Stamps
Early Head Start
Medicaid
IEP/IFSP
Private Insurance/Seguro Privado
In foster care/en cuidado de crianza
In kinship care/En cuidado familiar
Expecting a baby/esperando un bebe
Not Applicable/No aplicable
42
Is your family homeless (temporarily living with friends/family or in a shelter/car/hotel)?/¿Su familia no tiene hogar (vive temporalmente con amigos/familiares o en un refugio/automóvil/hotel)?* This field is required.
No
Yes, more than 12 months/Sí, más de 12 meses.
Yes, less than 12 months/Sí, menos de 12 meses.
43
Current Living Situation:/Situación de vida actual:* This field is required.If Other is selected, please explain./Si se selecciona Otro, explique.
In a shelter/en un refugio
In own home/en casa propia
In your own home, rented home, or apartment/En tu propia casa, casa alquilada o apartamento
In a hotel or motel/En un hotel o motel
With friends or relatives/Con amigos o familiares
Other
44
Have you moved in the last 12 months?/¿Se ha mudado en los últimos 12 meses?* This field is required.
Please Select
Please Select
Yes
No
If yes, please specify how many times and what were the circumstances for moving. /En caso afirmativo, especifique cuántas veces y cuáles fueron las circunstancias para mudarse.
45
I am homeless and give Head Start (Blue Ridge Community Action) and/or Caldwell County Schools permission to make a referral for services./No tengo hogar y doy permiso a Head Start (Acción Comunitaria de Blue Ridge) y/o a las Escuelas del Condado de Caldwell para hacer una referencia para servicios.* This field is required.
YESNO
46
Are you only applying for Jump Start or Tuition (not Head Start or NCPK)?/¿Está solicitando únicamente Jump Start o Matrícula (no Head Start or NCPK)?* This field is required.
YESNO
47
The next section collects information about household income. This information is required for consideration of Head Start and NCPK placement. Do you wish to be considered for one of these programs?/La siguiente sección recopila información sobre los ingresos del hogar. Esta información es necesaria para considerar la colocación en Head Start y NCPK. ¿Desea ser considerado para uno de estos programas?Please read: The NCPK household income for 25-26 is on a sliding scale. Example: A family of 4 earning $82,000/year qualifies for the program. If you are applying for a tuition slot but wish to be considered for NCPK as well (in case you qualify), please select Yes. If you only want to be considered for a tuition slot, please select No./Lea: Los ingresos de los hogares de NCPK entre 25 y 26 años están en una escala móvil. Ejemplo: una familia de 4 personas que ganan $82 000 al año califica para el programa. Si está solicitando un lugar para la matrícula pero también desea ser considerado para NCPK (en caso de que califique), seleccione Sí. Si solo desea ser considerado para un puesto de matrícula, seleccione No.
YESNO
48
Income Verification/Verificación de ingresosIn order for your application to be processed, we will need income verification information. Please check any boxes that you will be providing./Para que se procese su solicitud, necesitaremos información de verificación de ingresos. Marque las casillas que proporcionará.
49
Who does your child live with at least 51% of the time?/¿Con quién vive su hijo al menos el 51% del tiempo?* This field is required.
Mother Only/solo madre
Father Only/solo padre
Mother/Stepmother and Father/Stepfather/Madre/Madrastra y Padre/Padrastro
Legal Guardian/Tutor Legal
Legal Custodian/Custodio Legal
Other
50
Mother/Stepmother/Guardian's Name/Nombre de la madre/madrastra/tutor
Name/Nombre
Please Select
Please Select
Mother
Stepmother
Guardian
Please tell us your relationship to the child. /Por favor díganos su relación con el niño.
51
Mother/Stepmother/Guardian's Address/Dirección de la madre/madrastra/tutor
Street Address/Dirección
Street Address Line 2/Dirección de calle Línea 2
City/Ciudad
Postal/Zip Code/Código postal
Home Phone/Teléfono residencial
Cell/Mobile Phone/Teléfono celular/móvil
52
Mother/Stepmother/Guardian's Email Address/Dirección de correo electrónico de la madre/madrastra/tutor* This field is required.Emails are collected because information is sent on email first in order to quickly make notifications regarding your application./Los correos electrónicos se recopilan porque la información se envía primero por correo electrónico para poder realizar notificaciones rápidamente sobre su solicitud.
example@example.com
53
Mother/Guardian: Student Status/Madre/Tutor: Estado de estudianteIf other is selected, please explain./Si se selecciona otro, explique.
High School GED/GED de escuela secundaria
College/Colega
Job Training Program/Programa de Capacitación Laboral
None/Ninguno
Other
54
Mother/Stepmother/Guardian's Income/Ingresos de la madre/madrastra/tutorPlease check all sources of income. After this question, you will be asked about the specific amounts of income you receive from each source you select. All income must be verified with paystubs, benefits letters, or bank statements for NCPK and Head Start applications./Por favor marque todas las fuentes de ingresos. Después de esta pregunta, se le preguntará sobre las cantidades específicas de ingresos que recibe de cada fuente que seleccione. Todos los ingresos deben verificarse con recibos de sueldo, cartas de beneficios o extractos bancarios para solicitudes de NCPK y Head Start.
Employment Wages/Salarios de empleo
Alimony/Pensión alimenticia
Child Support/Manutención infantil
Worker's Compensation/Compensación al trabajador
Unemployment/Desempleo
Work First/ TANF/Trabajar primero/TANF
Social Security/Seguridad social
Social Security/Disability/Seguridad Social/Incapacidad
VA Benefits/Beneficios de VA
Pension/Annuity/Pensión/Anualidad
Family Support/Apoyo familiar
Other
55
Mother/Stepmother/Guardian: Are you currently employed?/Madre/Madrastra/Tutor: ¿Está usted empleado actualmente?
YESNO
56
Mother/Stepmother/Guardian's Income/Ingresos de la madre/madrastra/tutorBased on your answers, you currently have $0 income./Según sus respuestas, actualmente tiene $0 de ingreso.
Please Select
Please Select
YES
NO
Is this correct? /¿Es esto correcto?
How long have you had $0 income? Example: When was the last date you were employed? /¿Cuánto tiempo ha tenido $0 de ingreso? Ejemplo: ¿Cuándo fue la última fecha en que estuvo empleado?
57
Mother/Stepmother/Guardian: Please sign with full signature and date if you are unemployed and $0 income status./Madre/Madrastra/Tutor: Por favor firme con firma completa y fecha si está desempleado y tiene un ingreso de $0.Full signature please/firma completa por favor
Clear
58
Employment Wages (mother, stepmother, guardian)/Empleo Salarios (madre, madrastra, tutor)Tell us how much you earn in your job. (Reminder: You must provide copies of the most recent two months' paystubs.)/Cuéntanos cuánto ganas en tu trabajo. (Recordatorio: debe proporcionar copias de los recibos de sueldo de los dos meses más recientes).
Tell us how much your total pay is on your paystub. /Díganos cuánto es su pago total en su talón de pago.
Please Select
Please Select
Weekly
Bi-weekly
Twice per month
Monthly
How often do you get paid? /¿Con qué frecuencia le pagan?
How many hours do you work in a pay period?/¿Cuántas horas trabaja en un período de pago?
Employer/Empleador
Employer Phone/Teléfono del empleador
59
Social Security Disability/Incapacidad del Seguro SocialIf you receive Social Security Disability benefits, you will need to submit your most recent benefits letter./Si recibe beneficios por incapacidad del Seguro Social, deberá presentar su carta de beneficios más reciente.
Tell us how much your payments are. /Díganos a cuánto ascienden sus pagos.
Please Select
Please Select
Weekly/Semanalmente
Bi-weekly/Quincenal
Twice per month/Dos veces por mes
Monthly/Mensual
How often do you get paid?/¿Con qué frecuencia le pagan?
Who is the disability benefit for?/¿A quién va dirigida la prestación por incapacidad?
60
Family Support/Apoyo familiarIf you receive financial support from your family, verification of income may be a letter from the family member(s) stating the amount and frequency of payments. Such a letter must include the family member(s) name, address, and contact information./Si recibe apoyo financiero de su familia, la verificación de ingresos puede ser una carta de los miembros de la familia indicando el monto y la frecuencia de los pagos. Dicha carta debe incluir el nombre, la dirección y la información de contacto de los miembros de la familia.
Tell us how much your payments are. /Díganos a cuánto ascienden sus pagos.
Please Select
Please Select
Weekly/semanalmente
Bi-weekly/Quincenal
Twice per month/Dos veces por mes
Monthly/Mensual
How often do you receive support payments?/¿Con qué frecuencia recibe pagos de manutención?
Family member(s) name and address who you will provide a letter from. /Nombre y dirección de los miembros de la familia de quienes proporcionará una carta.
61
Other Financial Support/Otro apoyo financieroIf you receive financial support other than those listed, please tell us about that income. Verification of this type of income will vary./Si recibe apoyo financiero distinto de los enumerados, infórmenos sobre esos ingresos. La verificación de este tipo de ingresos variará.
Tell us what kind of financial support you receive. /Cuéntanos qué tipo de apoyo financiero recibes.
Tell us how much your payments are. /Díganos a cuánto ascienden sus pagos.
Please Select
Please Select
Weekly/semanalmente
Bi-weekly/Quincenal
Twice per month/Dos veces por mes
Monthly/Mensual
How often do you receive support?/¿Con qué frecuencia recibe soporte?
62
Mother/Stepmother/Guardian Other Income/Madre/Madrastra/Tutor Otros IngresosPlease tell us about your income. For each type of income you receive, you will need to submit verification which may include bank statements, paystubs, benefits letters, etc./Por favor cuéntenos sobre sus ingresos. Para cada tipo de ingreso que reciba, deberá presentar una verificación que puede incluir extractos bancarios, recibos de sueldo, cartas de beneficios, etc.
Income Received/Ingresos recibidos
Frequency of Payments/Frecuencia de pagos
Payments Received By/Pagos recibidos por
Alimony/Pensión alimenticia
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Child Support/Manutención infantil
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Worker's Compensation/Compensación al trabajador
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Unemployment/Desempleo
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
WorkFirst/TANF/TrabajoPrimero/TANF/
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Social Security Retirement/Jubilación del Seguro Social
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
VA Benefits/Beneficios de VA
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Pension/Annuity/Pensión/Anualidad
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Alimony/Pensión alimenticia
Child Support/Manutención infantil
Worker's Compensation/Compensación al trabajador
Unemployment/Desempleo
WorkFirst/TANF/TrabajoPrimero/TANF/
Social Security Retirement/Jubilación del Seguro Social
VA Benefits/Beneficios de VA
Pension/Annuity/Pensión/Anualidad
Income Received/Ingresos recibidos
Row 0, Column 0
Frequency of Payments/Frecuencia de pagos
Row 0, Column 1
Payments Received By/Pagos recibidos por
Row 0, Column 2
Income Received/Ingresos recibidos
Row 1, Column 0
Frequency of Payments/Frecuencia de pagos
Row 1, Column 1
Payments Received By/Pagos recibidos por
Row 1, Column 2
Income Received/Ingresos recibidos
Row 2, Column 0
Frequency of Payments/Frecuencia de pagos
Row 2, Column 1
Payments Received By/Pagos recibidos por
Row 2, Column 2
Income Received/Ingresos recibidos
Row 3, Column 0
Frequency of Payments/Frecuencia de pagos
Row 3, Column 1
Payments Received By/Pagos recibidos por
Row 3, Column 2
Income Received/Ingresos recibidos
Row 4, Column 0
Frequency of Payments/Frecuencia de pagos
Row 4, Column 1
Payments Received By/Pagos recibidos por
Row 4, Column 2
Income Received/Ingresos recibidos
Row 5, Column 0
Frequency of Payments/Frecuencia de pagos
Row 5, Column 1
Payments Received By/Pagos recibidos por
Row 5, Column 2
Income Received/Ingresos recibidos
Row 6, Column 0
Frequency of Payments/Frecuencia de pagos
Row 6, Column 1
Payments Received By/Pagos recibidos por
Row 6, Column 2
Income Received/Ingresos recibidos
Row 7, Column 0
Frequency of Payments/Frecuencia de pagos
Row 7, Column 1
Payments Received By/Pagos recibidos por
Row 7, Column 2
1 of 8
63
Father/Stepfather/Guardian's Name/Nombre del padre/padrastro/tutor
First Name/Nombre de pila
Last Name/Apellido
64
Father/Stepfather/Guardian's Address/Dirección del padre/padrastro/tutor
Street Address/Dirección
Street Address Line 2/Dirección de calle Línea 2
City/Ciudad
Postal/Zip Code/Código postal
Home Phone/Teléfono residencial
Cell/Mobile Phone/Teléfono celular/móvil
65
Father/Stepfather/Guardian's Email/Correo electrónico del padre/padrastro/tutor* This field is required.Emails are collected because information is sent on email first in order to quickly make notifications regarding your application. (If child lives primarily with mother, please enter mother's email address again.)/Los correos electrónicos se recopilan porque la información se envía primero por correo electrónico para poder realizar notificaciones rápidamente sobre su solicitud. (Si el niño vive principalmente con la madre, ingrese nuevamente la dirección de correo electrónico de la madre).
example@example.com
66
Father/Guardian: Student Status/Padre/Tutor: Estado de EstudianteIf other is selected, please explain.
High School GED
College
Job Training Program
None
Other
67
Father/Stepfather/Guardian's IncomePlease check all sources of income. After this question, you will be asked about the specific amounts of income you receive from each source you select. All income must be verified with paystubs, benefits letters, or bank statements for NCPK and Head Start applications.
Employment Wages
Alimony
Child Support
Worker's Compensation
Unemployment
Work First/ TANF
Social Security
Social Security/Disability
VA Benefits
Pension/Annuity
Family Support
Other
68
Father/Guardian: Are you currently employed?
YESNO
69
Father/Stepfather/Guardian's IncomeBased on your answers, you currently have $0 income.
Please Select
Please Select
YES
NO
Is this correct?
How long have you had $0 income? Example: When was the last date you were employed?
70
Father/Stepfather/Guardian: Please sign with full signature and date if you are unemployed and have $0 income.Full signature please
Clear
71
Employment Wages (father, stepfather, guardian)Tell us how much you earn in your job. (Reminder: You must provide copies of the most recent two months' paystubs.)
Tell us how much your total pay is on your paystub.
Please Select
Please Select
Weekly
Biweekly/Every other week
Twice per month
Monthly
How often do you get paid?
How many hours do you work in a pay period?
72
Social Security Disability If you receive Social Security Disability benefits, you will need to submit your most recent benefits letter.
Tell us how much your payments are.
Please Select
Please Select
Option 1
Option 2
Option 3
How often do you get paid?
Who is the disability benefit for?
73
Family Support If you receive financial support from your family, verification of income may be a letter from the family member(s) stating the amount and frequency of payments. Such a letter must include the family member(s) name, address, and contact information.
Tell us how much your payments are.
Please Select
Please Select
Weekly
Biweekly/Every other week
Twice per month
Monthly
How often do you receive support?
74
Other Financial Support If you receive financial support other than those listed, please tell us about that income. Verification of this type of income will vary.
Tell us what kind of financial support you receive.
Tell us how much your payments are.
Please Select
Please Select
Weekly
Biweekly/Every other week
Twice per month
Monthly
How often do you receive support?
75
Father/Stepfather/Guardian Other IncomePlease tell us about your income. For each type of income you receive, you will need to submit verification which may include bank statements, paystubs, benefits letters, etc.
Income Received
Frequency of Payments
Payments Received By
Alimony
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Child Support
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Worker's Compensation
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Unemployment
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
WorkFirst/TANF
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Social Security Retirement
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
VA Benefits
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Pension/Annuity
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Alimony
Child Support
Worker's Compensation
Unemployment
WorkFirst/TANF
Social Security Retirement
VA Benefits
Pension/Annuity
Income Received
Row 0, Column 0
Frequency of Payments
Row 0, Column 1
Payments Received By
Row 0, Column 2
Income Received
Row 1, Column 0
Frequency of Payments
Row 1, Column 1
Payments Received By
Row 1, Column 2
Income Received
Row 2, Column 0
Frequency of Payments
Row 2, Column 1
Payments Received By
Row 2, Column 2
Income Received
Row 3, Column 0
Frequency of Payments
Row 3, Column 1
Payments Received By
Row 3, Column 2
Income Received
Row 4, Column 0
Frequency of Payments
Row 4, Column 1
Payments Received By
Row 4, Column 2
Income Received
Row 5, Column 0
Frequency of Payments
Row 5, Column 1
Payments Received By
Row 5, Column 2
Income Received
Row 6, Column 0
Frequency of Payments
Row 6, Column 1
Payments Received By
Row 6, Column 2
Income Received
Row 7, Column 0
Frequency of Payments
Row 7, Column 1
Payments Received By
Row 7, Column 2
1 of 8
76
Highest Level of Education Attainment?/¿Nivel más alto de educación alcanzado?
Mother/ Madre
Mother working on/ Madre trabajando en
Father/ Padre
Father working on/ Padre trabajando en
Less than high school/Menos que la escuela secundaria
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
High School Diploma/High School Diploma
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
High School Equivalency/Equivalencia de escuela secundaria
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
Some College/algo de universidad
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
Associate Degree/Grado asociado
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
Bachelor Degree/Licenciatura
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
Master's Degree or higher/Maestría o superior
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
Less than high school/Menos que la escuela secundaria
High School Diploma/High School Diploma
High School Equivalency/Equivalencia de escuela secundaria
Some College/algo de universidad
Associate Degree/Grado asociado
Bachelor Degree/Licenciatura
Master's Degree or higher/Maestría o superior
Mother/ Madre
Row 0, Column 0
Mother working on/ Madre trabajando en
Row 0, Column 1
Father/ Padre
Row 0, Column 2
Father working on/ Padre trabajando en
Row 0, Column 3
Mother/ Madre
Row 1, Column 0
Mother working on/ Madre trabajando en
Row 1, Column 1
Father/ Padre
Row 1, Column 2
Father working on/ Padre trabajando en
Row 1, Column 3
Mother/ Madre
Row 2, Column 0
Mother working on/ Madre trabajando en
Row 2, Column 1
Father/ Padre
Row 2, Column 2
Father working on/ Padre trabajando en
Row 2, Column 3
Mother/ Madre
Row 3, Column 0
Mother working on/ Madre trabajando en
Row 3, Column 1
Father/ Padre
Row 3, Column 2
Father working on/ Padre trabajando en
Row 3, Column 3
Mother/ Madre
Row 4, Column 0
Mother working on/ Madre trabajando en
Row 4, Column 1
Father/ Padre
Row 4, Column 2
Father working on/ Padre trabajando en
Row 4, Column 3
Mother/ Madre
Row 5, Column 0
Mother working on/ Madre trabajando en
Row 5, Column 1
Father/ Padre
Row 5, Column 2
Father working on/ Padre trabajando en
Row 5, Column 3
Mother/ Madre
Row 6, Column 0
Mother working on/ Madre trabajando en
Row 6, Column 1
Father/ Padre
Row 6, Column 2
Father working on/ Padre trabajando en
Row 6, Column 3
1 of 7
77
Is at least one parent/guardian of this child currently an active duty member of the United States Armed Forces; or was ordered active duty within the last 18 months or expected to be ordered within the next 18 months; or has been seriously injured or killed in active duty?* This field is required.If yes, please provide documentation.
YESNO
78
Family Headcount/Número de familias* This field is required.Please list all family members living in the household (include step-parents) including those who are dependents (including step-siblings)./Enumere todos los miembros de la familia que viven en el hogar (incluidos los padrastros), incluidos los que son dependientes (incluidos los hermanastros).
Name/ Nombre
Birthdate/ Fecha de nacimiento
Current Age/ Edad actual
Relationship to Preschool Child/ Relación con el niño en edad preescolar
1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Row 0, Column 3
2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Row 1, Column 3
3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Row 2, Column 3
4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Row 3, Column 3
5
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Row 4, Column 3
6
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Row 5, Column 3
7
Row 6, Column 0
Row 6, Column 1
Row 6, Column 2
Row 6, Column 3
8
Row 7, Column 0
Row 7, Column 1
Row 7, Column 2
Row 7, Column 3
9
Row 8, Column 0
Row 8, Column 1
Row 8, Column 2
Row 8, Column 3
10
Row 9, Column 0
Row 9, Column 1
Row 9, Column 2
Row 9, Column 3
1
2
3
4
5
6
7
8
9
10
Name/ Nombre
Row 0, Column 0
Birthdate/ Fecha de nacimiento
Row 0, Column 1
Current Age/ Edad actual
Row 0, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 0, Column 3
Name/ Nombre
Row 1, Column 0
Birthdate/ Fecha de nacimiento
Row 1, Column 1
Current Age/ Edad actual
Row 1, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 1, Column 3
Name/ Nombre
Row 2, Column 0
Birthdate/ Fecha de nacimiento
Row 2, Column 1
Current Age/ Edad actual
Row 2, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 2, Column 3
Name/ Nombre
Row 3, Column 0
Birthdate/ Fecha de nacimiento
Row 3, Column 1
Current Age/ Edad actual
Row 3, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 3, Column 3
Name/ Nombre
Row 4, Column 0
Birthdate/ Fecha de nacimiento
Row 4, Column 1
Current Age/ Edad actual
Row 4, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 4, Column 3
Name/ Nombre
Row 5, Column 0
Birthdate/ Fecha de nacimiento
Row 5, Column 1
Current Age/ Edad actual
Row 5, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 5, Column 3
Name/ Nombre
Row 6, Column 0
Birthdate/ Fecha de nacimiento
Row 6, Column 1
Current Age/ Edad actual
Row 6, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 6, Column 3
Name/ Nombre
Row 7, Column 0
Birthdate/ Fecha de nacimiento
Row 7, Column 1
Current Age/ Edad actual
Row 7, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 7, Column 3
Name/ Nombre
Row 8, Column 0
Birthdate/ Fecha de nacimiento
Row 8, Column 1
Current Age/ Edad actual
Row 8, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 8, Column 3
Name/ Nombre
Row 9, Column 0
Birthdate/ Fecha de nacimiento
Row 9, Column 1
Current Age/ Edad actual
Row 9, Column 2
Relationship to Preschool Child/ Relación con el niño en edad preescolar
Row 9, Column 3
1 of 10
79
Alternative Contacts/ Contactos alternativos* This field is required.At least one alternative contact must be provided./Se debe proporcionar al menos un contacto alternativo.
Contact's Name/ Nombre del contacto
Phone during the day/ Teléfono durante el día
Relationship to the family/ Relación con la familia
1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
1
2
3
4
Contact's Name/ Nombre del contacto
Row 0, Column 0
Phone during the day/ Teléfono durante el día
Row 0, Column 1
Relationship to the family/ Relación con la familia
Row 0, Column 2
Contact's Name/ Nombre del contacto
Row 1, Column 0
Phone during the day/ Teléfono durante el día
Row 1, Column 1
Relationship to the family/ Relación con la familia
Row 1, Column 2
Contact's Name/ Nombre del contacto
Row 2, Column 0
Phone during the day/ Teléfono durante el día
Row 2, Column 1
Relationship to the family/ Relación con la familia
Row 2, Column 2
Contact's Name/ Nombre del contacto
Row 3, Column 0
Phone during the day/ Teléfono durante el día
Row 3, Column 1
Relationship to the family/ Relación con la familia
Row 3, Column 2
1 of 4
80
Mother/Stepmother/Guardian's Name/Nombre de la madre/madrastra/tutor
Name/ Nombre
Please Select
Please Select
Mother/Madre
Stepmother/Madrastra
Guardian/Tutor legal
Please tell us your relationship to the child. /Por favor díganos su relación con el niño.
81
Mother/Stepmother/Guardian's Address/Dirección de la madre/madrastra/tutor
Street Address/Dirección
Street Address Line 2/Dirección de calle Línea 2
City/Ciudad
Postal/Zip Code/Código postal
Home Phone/Teléfono residencial
Cell/Mobile Phone/Teléfono celular/móvil
82
Mother/Stepmother/Guardian's Email Address/Dirección de correo electrónico de la madre/madrastra/tutor* This field is required.Emails are collected because information is sent on email first in order to quickly make notifications regarding your application./Los correos electrónicos se recopilan porque la información se envía primero por correo electrónico para poder realizar notificaciones rápidamente sobre su solicitud.
example@example.com
83
Father/Stepfather/Guardian's Name/Nombre del padre/padrastro/tutor
First Name/Nombre de pila
Last Name/Apellido
84
Father/Stepfather/Guardian's Address/Dirección del padre/padrastro/tutor
Street Address/Dirección
Street Address Line 2/Dirección de calle Línea 2
City/Cuidad
Postal/Zip Code/Código postal
Home Phone/Teléfono residencial
Cell/Mobile Phone/Teléfono celular/móvil
85
Father/Stepfather/Guardian's Email/Correo electrónico del padre/padrastro/tutor* This field is required.Emails are collected because information is sent on email first in order to quickly make notifications regarding your application. (If child lives primarily with mother, please enter mother's email address again.)/ Los correos electrónicos se recopilan porque la información se envía primero por correo electrónico para poder realizar notificaciones rápidamente sobre su solicitud. (Si el niño vive principalmente con la madre, ingrese nuevamente la dirección de correo electrónico de la madre).
example@example.com
86
Alternative Contacts/Contactos alternativos* This field is required.At least one alternative contact must be provided./Se debe proporcionar al menos un contacto alternativo.
Contact's Name/ Nombre del contacto
Phone during the day/Teléfono durante el día
Relationship to the family/ Relación con la familia
1
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
2
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
3
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
4
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
1
2
3
4
Contact's Name/ Nombre del contacto
Row 0, Column 0
Phone during the day/Teléfono durante el día
Row 0, Column 1
Relationship to the family/ Relación con la familia
Row 0, Column 2
Contact's Name/ Nombre del contacto
Row 1, Column 0
Phone during the day/Teléfono durante el día
Row 1, Column 1
Relationship to the family/ Relación con la familia
Row 1, Column 2
Contact's Name/ Nombre del contacto
Row 2, Column 0
Phone during the day/Teléfono durante el día
Row 2, Column 1
Relationship to the family/ Relación con la familia
Row 2, Column 2
Contact's Name/ Nombre del contacto
Row 3, Column 0
Phone during the day/Teléfono durante el día
Row 3, Column 1
Relationship to the family/ Relación con la familia
Row 3, Column 2
1 of 4
87
Does your child have a physical challenge or chronic illness?/ ¿Su hijo tiene un desafío físico o una enfermedad crónica?* This field is required.*A medical diagnosis is required. Verification from your child's physician must be provide with the application. If Other is selected, please explain./ *Se requiere diagnóstico médico. Se debe proporcionar la verificación del médico de su hijo con la solicitud. Si se selecciona Otro, explique.
No
asthma/asma
diabetes/diabetes
obesity/obesidad
anemia/anemia
Other
88
Does your child have a developmental or educational need?/ ¿Tiene su hijo una necesidad educativa o de desarrollo?* This field is required.
Please Select
Please Select
Yes/Si
No
If you selected YES, please tell us about your child's developmental or educational needs. /Si seleccionó SÍ, infórmenos sobre las necesidades educativas o de desarrollo de su hijo.
89
Has your child has recently had a developmental screening?/ ¿Su hijo ha tenido recientemente un examen de desarrollo?* This field is required.
No. My child has not had a developmental screening./No. Mi hijo no ha tenido una prueba de desarrollo.
Yes. My child has had a developmental screening. (Please check this response and enter the date below)/Sí. Mi hijo ha tenido un examen de desarrollo. (Por favor marque esta respuesta e ingrese la fecha a continuación)
Other
90
Testing: Has your child been referred or recommended for testing to determine if services are needed to help developmental or educational needs?/ Pruebas: ¿Su hijo ha sido remitido o recomendado para que se le realicen pruebas para determinar si se necesitan servicios para ayudar con sus necesidades educativas o de desarrollo?
Yes/ Si
No
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Speech Therapy/Terapia del habla
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Physical Therapy/ Fisioterapia
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Occupational Therapy/Terapia Ocupacional
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Play Therapy/Terapia de juego
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Counseling/Asesoramiento
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Other/Otro
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Speech Therapy/Terapia del habla
Physical Therapy/ Fisioterapia
Occupational Therapy/Terapia Ocupacional
Play Therapy/Terapia de juego
Counseling/Asesoramiento
Other/Otro
Yes/ Si
Row 0, Column 0
No
Row 0, Column 1
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Row 0, Column 2
Yes/ Si
Row 1, Column 0
No
Row 1, Column 1
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Row 1, Column 2
Yes/ Si
Row 2, Column 0
No
Row 2, Column 1
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Row 2, Column 2
Yes/ Si
Row 3, Column 0
No
Row 3, Column 1
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Row 3, Column 2
Yes/ Si
Row 4, Column 0
No
Row 4, Column 1
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Row 4, Column 2
Yes/ Si
Row 5, Column 0
No
Row 5, Column 1
Not referred, but I have concerns./ No referido, pero tengo preocupaciones.
Row 5, Column 2
1 of 6
91
Referral for Testing to Determine Developmental or Educational Need/Referencia para pruebas para determinar la necesidad educativa o de desarrolloPlease tell us about testing completed for therapies and services for your child including the type of service and which agency is providing those services. /Infórmenos sobre las pruebas realizadas para terapias y servicios para su hijo, incluido el tipo de servicio y qué agencia brinda esos servicios.
92
What services is your child receiving for a developmental or educational need?/¿Qué servicios recibe su hijo por una necesidad educativa o de desarrollo?
Current Services/ Servicios actuales
Previous Services/ Servicios anteriores
Never / Nunca
Speech Therapy/Terapia del habla
Row 0, Column 0
Row 0, Column 1
Row 0, Column 2
Occupational Therapy/Terapia Ocupacional
Row 1, Column 0
Row 1, Column 1
Row 1, Column 2
Physical Therapy/Physical Therapy
Row 2, Column 0
Row 2, Column 1
Row 2, Column 2
Play Therapy/Terapia de juego
Row 3, Column 0
Row 3, Column 1
Row 3, Column 2
Counseling/Asesoramiento
Row 4, Column 0
Row 4, Column 1
Row 4, Column 2
Other/Otro
Row 5, Column 0
Row 5, Column 1
Row 5, Column 2
Speech Therapy/Terapia del habla
Occupational Therapy/Terapia Ocupacional
Physical Therapy/Physical Therapy
Play Therapy/Terapia de juego
Counseling/Asesoramiento
Other/Otro
Current Services/ Servicios actuales
Row 0, Column 0
Previous Services/ Servicios anteriores
Row 0, Column 1
Never / Nunca
Row 0, Column 2
Current Services/ Servicios actuales
Row 1, Column 0
Previous Services/ Servicios anteriores
Row 1, Column 1
Never / Nunca
Row 1, Column 2
Current Services/ Servicios actuales
Row 2, Column 0
Previous Services/ Servicios anteriores
Row 2, Column 1
Never / Nunca
Row 2, Column 2
Current Services/ Servicios actuales
Row 3, Column 0
Previous Services/ Servicios anteriores
Row 3, Column 1
Never / Nunca
Row 3, Column 2
Current Services/ Servicios actuales
Row 4, Column 0
Previous Services/ Servicios anteriores
Row 4, Column 1
Never / Nunca
Row 4, Column 2
Current Services/ Servicios actuales
Row 5, Column 0
Previous Services/ Servicios anteriores
Row 5, Column 1
Never / Nunca
Row 5, Column 2
1 of 6
93
Does your child have a current IEP (Individualized Education Plan) or IFSP (Individual Family Service Plan)?/¿Tiene su hijo un IEP (Plan de Educación Individualizado) o IFSP (Plan de Servicios Familiares Individualizados) actual?* This field is required.If your child has an IEP through a school system other than Caldwell County Schools, you will need to provide a copy of the most recent IEP./Si su hijo tiene un IEP a través de un sistema escolar que no sea las escuelas del condado de Caldwell, deberá proporcionar una copia del IEP más reciente.
No.
Yes. My child has a current IEP through Caldwell County Schools./Sí. Mi hijo tiene un IEP vigente a través de las Escuelas del Condado de Caldwell.
Yes. My child has a current IEP through a different school system./Sí. Mi hijo tiene un IEP actual a través de un sistema escolar diferente.
Other
94
Does your child have a sibling who is currently being serviced under an Individualized Education Plan (IEP) or Individualized Family Service Plan (IFSP)?/¿Tiene su hijo un hermano que actualmente recibe servicios bajo un Plan de Educación Individualizado (IEP) o un Plan de Servicios Familiares Individualizados (IFSP)?
Please Select
Please Select
Yes/Si
No
I'm not sure/No estoy seguro
What school district provides IEP services for the sibling. /Qué distrito escolar proporciona servicios de IEP para el hermano.
Full Name of the sibling with an IEP.
95
My child has attended a child care center or family care home./Mi hijo ha asistido a un centro de cuidado infantil o a un hogar de cuidado familiar.
Please Select
Please Select
Attending currently, paid by family/Asistiendo actualmente, pagado por la familia.
Attending currently, paid by subsidy voucher/Asistiendo actualmente, pagado mediante bono de subsidio.
Attended previously but is not currently enrolled in a child care setting/Asistió anteriormente pero no está inscrito actualmente en un entorno de cuidado infantil
Never/Nunca
If your child is not currently attending a child care setting, please tell us who attends your child during the day. /Si su hijo no asiste actualmente a un centro de cuidado infantil, infórmenos quién lo atiende durante el día.
96
Child Care Information/Información sobre cuidado infantil
Name of CURRENT child care center/home child care/Nombre del centro de cuidado infantil/cuidado infantil en el hogar ACTUAL
Start Date/Fecha de inicio
Number of hours attending weekly/Número de horas de asistencia semanal
Name of PREVIOUS child care center/home child care/Nombre del centro de cuidado infantil/cuidado infantil en el hogar ANTERIOR
End Date/Fecha de finalización
Number of hours attended weekly/Número de horas atendidas semanalmente
97
Subsidy/Childcare Voucher/Subsidio/Bono de guardería
Please Select
Please Select
Yes/Si
No
Have you applied for subsidy and are on a wait list?/¿Ha solicitado subsidio y está en lista de espera?
Please Select
Please Select
Yes/Si
No
Are you eligible for subsidy?/¿Tiene derecho a recibir subsidio?
98
What other family circumstances should be considered for this child's enrollment./Qué otras circunstancias familiares se deben considerar para la inscripción de este niño.
Currently in the home/ Actualmente en el hogar
Not in the home/No en la casa
Parental substance abuse/Abuso de sustancias por parte de los padres
Row 0, Column 0
Row 0, Column 1
Parent currently incarcerated/Padre actualmente encarcelado
Row 1, Column 0
Row 1, Column 1
Parent released from incarceration within the last 6 months/Padre liberado de prisión en los últimos 6 meses
Row 2, Column 0
Row 2, Column 1
Diagnosed parental physical illness/disability/Enfermedad o discapacidad física de los padres diagnosticada
Row 3, Column 0
Row 3, Column 1
Diagnosed parental mental illness /Enfermedad mental de los padres diagnosticada
Row 4, Column 0
Row 4, Column 1
Domestic violence/Violencia doméstica
Row 5, Column 0
Row 5, Column 1
Other/Otro
Row 6, Column 0
Row 6, Column 1
Parental substance abuse/Abuso de sustancias por parte de los padres
Parent currently incarcerated/Padre actualmente encarcelado
Parent released from incarceration within the last 6 months/Padre liberado de prisión en los últimos 6 meses
Diagnosed parental physical illness/disability/Enfermedad o discapacidad física de los padres diagnosticada
Diagnosed parental mental illness /Enfermedad mental de los padres diagnosticada
Domestic violence/Violencia doméstica
Other/Otro
Currently in the home/ Actualmente en el hogar
Row 0, Column 0
Not in the home/No en la casa
Row 0, Column 1
Currently in the home/ Actualmente en el hogar
Row 1, Column 0
Not in the home/No en la casa
Row 1, Column 1
Currently in the home/ Actualmente en el hogar
Row 2, Column 0
Not in the home/No en la casa
Row 2, Column 1
Currently in the home/ Actualmente en el hogar
Row 3, Column 0
Not in the home/No en la casa
Row 3, Column 1
Currently in the home/ Actualmente en el hogar
Row 4, Column 0
Not in the home/No en la casa
Row 4, Column 1
Currently in the home/ Actualmente en el hogar
Row 5, Column 0
Not in the home/No en la casa
Row 5, Column 1
Currently in the home/ Actualmente en el hogar
Row 6, Column 0
Not in the home/No en la casa
Row 6, Column 1
1 of 7
99
How often do you read to your child?/¿Con qué frecuencia le lees a tu hijo?
Daily/A diario
3-5 times per week/3-5 veces por semana
1-2 times per week/1-2 veces por semana
a few times per month/algunas veces al mes
occasionally/occasionally
100
My child does not receive free Dolly Parton Imagination Library books. Please send me information to enroll him/her through Caldwell Smart Start./Mi hijo no recibe libros gratuitos de la Biblioteca Dolly Parton Imagination. Por favor envíeme información para inscribirlo a través de Caldwell Smart Start.
YESNO
101
Please carefully read the following statements and confirm your understanding.* This field is required.
Yes/Sí
No
I understand that by completing this application, my child is not guaranteed placement and that he/she may be on a waiting list. /Entiendo que al completar esta solicitud, no se garantiza la colocación de mi hijo y que puede estar en una lista de espera.
Row 0, Column 0
Row 0, Column 1
I understand that if my child is selected for participation, family involvement is essential. My family will cooperate with programs to submit the necessary documentation and application for additional services. /Entiendo que si mi hijo es seleccionado para participar, la participación de la familia es esencial. Mi familia cooperará con los programas para presentar la documentación necesaria y la solicitud de servicios adicionales.
Row 1, Column 0
Row 1, Column 1
I understand that transportation to and from Pre-K programs will be my family's responsibility./Entiendo que el transporte hacia y desde los programas de Pre-K será responsabilidad de mi familia.
Row 2, Column 0
Row 2, Column 1
I understand that my child will receive a developmental screening in the primary language listed in the application and give permission for my child to also receive vision, hearing, dental, and/or speech and language screenings./Entiendo que mi hijo recibirá un examen de desarrollo en el idioma principal que figura en la solicitud y doy permiso para que mi hijo también reciba exámenes de visión, audición, dentales y/o del habla y el lenguaje.
Row 3, Column 0
Row 3, Column 1
I understand that if there is a change in my child's address, phone number, or attendance in any type of licensed care, or if there is a change in family income, it is my responsibility to notify the Caldwell County Schools Preschool Readiness Center and inform them of any changes. /Entiendo que si hay un cambio en la dirección, número de teléfono o asistencia de mi hijo a cualquier tipo de cuidado autorizado, o si hay un cambio en los ingresos familiares, es mi responsabilidad notificar al Centro de Preparación Preescolar de las Escuelas del Condado de Caldwell e informar informarles de cualquier cambio.
Row 4, Column 0
Row 4, Column 1
I understand that my child will need a current, updated health assessment which includes dental, vision, hearing and an updated immunization record, before she/he attends a program. (Health Transmittal form for NC is available in most Caldwell County doctor's offices.)/Entiendo que mi hijo necesitará una evaluación de salud actual y actualizada que incluya dentista, visión, audición y un registro de vacunas actualizado, antes de asistir a un programa. (El formulario de transmisión de salud para Carolina del Norte está disponible en la mayoría de los consultorios médicos del condado de Caldwell).
Row 5, Column 0
Row 5, Column 1
I understand that, if my child is accepted into the NC Pre-Kindergarten Program and/or Head Start, regular attendance is required for full benefit of the program. Failure to maintain regular attendance could jeopardize his/her placement in the program. /Entiendo que, si mi hijo es aceptado en el Programa de Pre-Kindergarten de Carolina del Norte y/o Head Start, se requiere asistencia regular para obtener el beneficio completo del programa. No mantener una asistencia regular podría poner en peligro su colocación en el programa.
Row 6, Column 0
Row 6, Column 1
I understand that my child's progress will be shared with his anticipated kindergarten school to help the school prepare for a successful transition for may child. Information may include his screenings and data collected in the preschool classroom. /Entiendo que el progreso de mi hijo se compartirá con la escuela de jardín de infantes prevista para ayudar a la escuela a prepararse para una transición exitosa para mi hijo. La información puede incluir sus exámenes y datos recopilados en el aula de preescolar.
Row 7, Column 0
Row 7, Column 1
I understand that by completing this application, my child is not guaranteed placement and that he/she may be on a waiting list. /Entiendo que al completar esta solicitud, no se garantiza la colocación de mi hijo y que puede estar en una lista de espera.
I understand that if my child is selected for participation, family involvement is essential. My family will cooperate with programs to submit the necessary documentation and application for additional services. /Entiendo que si mi hijo es seleccionado para participar, la participación de la familia es esencial. Mi familia cooperará con los programas para presentar la documentación necesaria y la solicitud de servicios adicionales.
I understand that transportation to and from Pre-K programs will be my family's responsibility./Entiendo que el transporte hacia y desde los programas de Pre-K será responsabilidad de mi familia.
I understand that my child will receive a developmental screening in the primary language listed in the application and give permission for my child to also receive vision, hearing, dental, and/or speech and language screenings./Entiendo que mi hijo recibirá un examen de desarrollo en el idioma principal que figura en la solicitud y doy permiso para que mi hijo también reciba exámenes de visión, audición, dentales y/o del habla y el lenguaje.
I understand that if there is a change in my child's address, phone number, or attendance in any type of licensed care, or if there is a change in family income, it is my responsibility to notify the Caldwell County Schools Preschool Readiness Center and inform them of any changes. /Entiendo que si hay un cambio en la dirección, número de teléfono o asistencia de mi hijo a cualquier tipo de cuidado autorizado, o si hay un cambio en los ingresos familiares, es mi responsabilidad notificar al Centro de Preparación Preescolar de las Escuelas del Condado de Caldwell e informar informarles de cualquier cambio.
I understand that my child will need a current, updated health assessment which includes dental, vision, hearing and an updated immunization record, before she/he attends a program. (Health Transmittal form for NC is available in most Caldwell County doctor's offices.)/Entiendo que mi hijo necesitará una evaluación de salud actual y actualizada que incluya dentista, visión, audición y un registro de vacunas actualizado, antes de asistir a un programa. (El formulario de transmisión de salud para Carolina del Norte está disponible en la mayoría de los consultorios médicos del condado de Caldwell).
I understand that, if my child is accepted into the NC Pre-Kindergarten Program and/or Head Start, regular attendance is required for full benefit of the program. Failure to maintain regular attendance could jeopardize his/her placement in the program. /Entiendo que, si mi hijo es aceptado en el Programa de Pre-Kindergarten de Carolina del Norte y/o Head Start, se requiere asistencia regular para obtener el beneficio completo del programa. No mantener una asistencia regular podría poner en peligro su colocación en el programa.
I understand that my child's progress will be shared with his anticipated kindergarten school to help the school prepare for a successful transition for may child. Information may include his screenings and data collected in the preschool classroom. /Entiendo que el progreso de mi hijo se compartirá con la escuela de jardín de infantes prevista para ayudar a la escuela a prepararse para una transición exitosa para mi hijo. La información puede incluir sus exámenes y datos recopilados en el aula de preescolar.
Yes/Sí
Row 0, Column 0
No
Row 0, Column 1
Yes/Sí
Row 1, Column 0
No
Row 1, Column 1
Yes/Sí
Row 2, Column 0
No
Row 2, Column 1
Yes/Sí
Row 3, Column 0
No
Row 3, Column 1
Yes/Sí
Row 4, Column 0
No
Row 4, Column 1
Yes/Sí
Row 5, Column 0
No
Row 5, Column 1
Yes/Sí
Row 6, Column 0
No
Row 6, Column 1
Yes/Sí
Row 7, Column 0
No
Row 7, Column 1
1 of 8
102
I give permission for my child’s name, picture, portrait, likeness, or voice to be used for the purpose of classroom center display, classroom scrapbook, newspaper articles, television broadcast, posting to Pre-K program websites, and/or printed materials for use by the Caldwell County Schools./Doy permiso para que el nombre, la fotografía, el retrato, la imagen o la voz de mi hijo se utilicen con fines de exhibición en el centro del aula, álbumes de recortes del aula, artículos periodísticos, transmisiones televisivas, publicaciones en sitios web de programas de Pre-K y/o materiales impresos para uso por las escuelas del condado de Caldwell.* This field is required.
YESNO
103
Are you interested in free classes to earn a high school equivalency diploma or to learn English?/¿Estás interesado en clases gratuitas para obtener un diploma equivalente a la escuela secundaria o aprender inglés?Caldwell County Family Literacy is an adult education program where you can earn a high school equivalency and/or English./Caldwell County Family Literacy es un programa de educación para adultos donde puedes obtener un equivalente de escuela secundaria y/o inglés.
Please Select
Please Select
Yes /Si
No
Please Select
Please Select
High School Equivalency/Equivalencia de escuela secundaria
Learning English/aprender ingles
Both/Ambos
Which program are you interested in learning more about?
104
I give permission for my name and contact information to be shared with Caldwell County Family Literacy regarding adult education programs that may benefit my family./Doy permiso para que mi nombre e información de contacto se compartan con Caldwell County Family Literacy con respecto a los programas de educación para adultos que puedan beneficiar a mi familia.* This field is required.
YESNO
105
Preferred Location- Please choose your first, second, third, and fourth choice for location by arranging your preferred locations in order (drag them to the top and put them in order 1-4 of your preference). Please remember that while every effort will be made to place eligible children in preferred locations, we are unable to guarantee a site. Sites below are subject to change due to funding and availability./Ubicación preferida: elija su primera, segunda, tercera y cuarta opción de ubicación organizando sus ubicaciones preferidas en orden (arrástrelas hacia la parte superior y colóquelas en el orden 1-4 de su preferencia). Recuerde que si bien se hará todo lo posible para ubicar a los niños elegibles en ubicaciones preferidas, no podemos garantizar un sitio. Los sitios a continuación están sujetos a cambios debido a la financiación y la disponibilidad.* This field is required.**Applicants only interested in Head Start will need to select Northside Children's Learning Center as their first choice./**Los solicitantes interesados únicamente en Head Start deberán seleccionar Northside Children's Learning Center como su primera opción.
106
Do you have documents that you would like to upload now? * This field is required.
YESNO
107
Child's Birth CertificateYou may upload a copy of your child's birth certificate here. (All uploaded documents must be clear and legible.)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
108
Child's Health FormThe health form is completed by your child's doctor. To be valid for the 2023-2024 school year, your child's visit must occur on or after September 1, 2023.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
109
Child's ImmunizationYou may upload your child's most recent immunization record here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
110
Family Income (not necessary for tuition-only applications)You may upload multiple files related to family income here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
111
Child CustodyIf a custody agreement or court order are in place for your child, you may submit a copy here.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
112
Other InformationAny additional information you would like to submit may be included here. (Example: medical diagnosis, confirmation of therapy records, IEP from a county other than Caldwell, etc.)
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
113
Please let us know if you have questions and would like someone to contact you.
Please Select
Please Select
Yes
No
Do you want someone to contact you?
What is the best phone number to reach you?
What is/are your questions concerning?
114
Please tell us who completed this application.* This field is required.
Name
Relationship to the child
115
I certify that all information provided in this application is true, correct, and complete. I understand that information is provided to document eligibility for receipt of program funds. Program staff may verify information on this application. Deliberate misrepresentation may subject me to prosecution under applicable state laws.Please Sign
Clear
116
Application Confirmation EmailWhat email do you want a confirmation sent to?
example@example.com
117
Thank you for visiting the Caldwell County Schools preschool application portal.

You can submit your application and supporting documents to the Preschool Readiness Center via mail, email, fax, or drop off. Applications for tuition slots are limited and on a first come, first serve basis. NCPK/Head Start slots have requirements for funding.

Preschool Readiness Center

332 Greenhaven Dr NW

Lenoir NC 28645

828-726-3920

828-754-0642 fax

lacoffey@caldwellschools.com

All applicants will be contacted if documentation is missing. Upon acceptance into the program, you will be notified. The earliest acceptance will be in late May. Remaining slots will be notified as applicants are verified for funding.
Should be Empty: