NC Pre-K Enrollment Form
2025-2026 school year
Child's Information
Child's Name
*
First Name
Middle Name
Last Name
Gender
*
Female
Male
Date of Birth
*
-
Month
-
Day
Year
Date
Copy of child's birth certificate
*
Browse Files
Drag and drop files here
Choose a file
Can not submit application without this document.
Cancel
of
Child's Ethnicity
*
Please Select
Child is Hispanic or Latino or of Spanish origin
Child is NOT Hispanic or Latino or of Spanish origin
Child's Race
*
White/European American
Native Hawaiian or other Pacific Islander
Native American Indian or Alaska Native
Black or African American
Asian
Is your child a U.S. Citizen?
*
Yes
No
Is your child a N.C. Resident?
*
Yes
No
County of Residence
*
Parent(s), Legal guardian(s), or Legal Custodian(s) Contact Information who live in the home
Name
*
First Name
Last Name
Email
*
example@example.com
Relationship
*
Mother, Father, etc
Mobile Phone Number
*
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Name
First Name
Last Name
Email
example@example.com
Relationship
Mother, Father, etc.
Mobile Phone Number
Please enter a valid phone number.
Work Phone Number
Please enter a valid phone number.
Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Copy of proof of residency to include physical address with no PO boxes. The following documents can be accepted: lease agreement, rental receipt, utility bill, current listing on income tax form, personal property tax listing and banking statements. NO phone or cable bills or driver's licenses accepted. If you live with someone and do not have any mail in your name at your address, you will need to complete the verification of residency form. You can obtain this form from our office.
*
Browse Files
Drag and drop files here
Choose a file
Can not submit application without this document.
Cancel
of
Mailing Address (if different from HOME address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Child lives with:
*
Both parents in the same home
Single Mother
Single Father
Parent and Step-parent
Legal guardian
Legal Custodian
I consider my family to be:
*
Homeless
Have adequate housing
List ALL living in the child's home (parents, step-parents, guardians, custodians, siblings, step-siblings, etc.)
*
Name
Date of Birth
Age
Relationship to Pre-K child
Name
Name
Name
Name
Name
Name
Name
Name
Name
Name
REQUIRED Income Verification
DO NOT LEAVE THIS PORTION BLANK - Submit verification of income OR sign the box verifying that you do not receive income of any kind.
Mother's/stepmother's/guardian's Name
First Name
Last Name
Employed?
*
Yes
No
NA
Place of employment and work telephone number:
Did you work at this place of employment the full year in 2024?
Yes
No
If you did not work at this place of employment the full year of 2024, how many months did you work at this place of employment?
Mother is:
Seeking employment
Attending secondary education
Attending high school/GED
Attending job training
Other
I verify that I DO NOT receive income of any kind
Mother's Income
$
Yearly
monthly
twice monthly
bi-weekly
weekly
Income BEFORE taxes
Overtime
Child support
Worker's comp
Unemployment
SSA/SSDI
Father's/stepfather's/guardian's Name
First Name
Last Name
Employed?
*
Yes
No
NA
Place of employment and work telephone number:
Did you work at this place of employment the full year in 2024?
Yes
No
If you did not work at this place of employment the full year of 2024, how many months did you work at this place of employment?
Father is:
Seeking employment
Attending secondary education
Attending high school/GED
Attending job training
Other
I verify that I DO NOT receive income of any kind
Father's Income
$
Yearly
monthly
twice monthly
bi-weekly
weekly
Income BEFORE taxes
Overtime
Child support
Worker's comp
Unemployment
SSA/SSDI
Income verification- W-2 2024 form or one month of pay stubs (family income is the primary criteria for NC Pre-K). Submit the most up-to-date and accurate information about your family's income.
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Family information
Language spoken most often in our home is:
*
How would you like to receive communication (language)?
*
Does your child have a chronic health condition? If yes, submit note from doctor
*
Yes
No
Chronic health condition doctor note
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Is your child currently receiving services for a developmental or educational need (Speech, OT, PT) ? If yes, submit copy of the documentation.
*
Yes
No
Developmental/education need documentation copy
Browse Files
Drag and drop files here
Choose a file
If you selected yes that your child receives services, you must submit proof of documentation.
Cancel
of
Military status of parent/legal guardian
*
Active duty in US armed forces
Active duty in NC National Guard
Reserve Unit of armed forces and ordered to active duty in past or next 18months
One parent or legal guardian of this child was seriously injured or killed while on active duty
Not applicable
If your child is not in child care now, has he/she ever been in a child care program?
*
Yes
No
Name of Child Care Center, Head Start or other facility that cared for your child
Does your child have a DSS voucher to assist with the cost of day care?
*
Yes
No
Who currently cares for your child when you are at work or school?
*
Child care center
Parent/home
Relative
Head Start
Other
Name of Child Care Center, Head Start or other facility that cares for your child currently
If your child receives educational or developmental services, please check all that apply:
*
Autistic Services
Speech Therapy
Educational Services
Occupational Therapy
Physical Therapy
NA
Who provides these services?
Does your child have an IEP
*
Yes
No
If yes, submit a copy of the IEP
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Family Responsibilities
Please read carefully and initial each box
I give permission for my child to receive developmental, hearing, vision, dental, speech/language, and any other screenings and for the results of these screenings to be shared with partnering Pre-K Programs.
I understand that if my child is selected for participation, family involvement is expected. My family will cooperate with programs to submit necessary documentation and applications for additional services.
I understand that transportation to and from Pre-K programs will be the family's responsibility.
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 change in family income, it is my responsibility to notify the NC Pre-K Department at Stanly County Partnership for Children and inform them of any changes.
I understand that my child will be required to have a current, updated health assessment before s/he attends a program.
I understand that my child may be placed on a waiting list.
I certify that all information provided 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 North Carolina state laws.
*
Date
*
-
Month
-
Day
Year
Date
Relationship to child.*IF legal guardian/custodian, court ordered documents must accompany; this application before it can be processed.
*
Court documents
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Pre-K Sites
Please indicate your top 3 preferences. 1 star being your top option. *PLEASE NOTE: THIS LIST IS SUBJECT TO CHANGE. YOU WILL BE NOTIFIED BY PHONE IF FACILITIES ARE REMOVED FROM OR ADDED TO THIS LIST.
All Star Learning Center 704-463-4422 34455 Springdale Drive, New London, NC 28127
1
2
3
4
5
Kiddie Kare Too 704-982-9018 438 North Fourth Street, Albemarle, NC 28001
1
2
3
4
5
Little Friends Learning Center 704-983-6610 1210 Freeman Avenue, Albemarle, NC 28001
1
2
3
4
5
Love-N-Care II 704-982-1079 1302 Mountain Creek Road, Albemarle, NC 28001
1
2
3
4
5
Love-N-Care West 704-983-6416 534 Coble Avenue, Albemarle, NC 28001
1
2
3
4
5
Oakboro Kid's Club 704-485-8800 206 North Main Street, Oakboro, NC 28129
1
2
3
4
5
Quality Child Care 704-485-8821 219 East First Street, Oakboro, NC 28129
1
2
3
4
5
Richfield Child Development Center 704-850-4040 233 Culp Road, Richfield, NC 28137
1
2
3
4
5
Document uploads
Need help? Tutorial for iphone users: https://shorturl.at/9f2nZ Tutorial for android users: https://shorturl.at/g92io
Child's Current Medical Report (completed within the last 12 months by the Dr.) Find medical report document here---->https://shorturl.at/3fwJ2
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Child's immunization record
Browse Files
Drag and drop files here
Choose a file
Cancel
of
Submit
Submit
Should be Empty: