NC Pre-K Enrollment Form

NC Pre-K Enrollment Form

2025-2026 school year

Name

First NameLast Name
Email
example@example.com
Relationship
Mother, Father, etc
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Name

First NameLast Name
Email
example@example.com
Relationship
Mother, Father, etc.
Mobile Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Work Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Home Address

Street Address

Street Address Line 2

CityState / 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.

Can not submit application without this document.
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Mailing Address (if different from HOME address)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Child lives with:
I consider my family to be:

List ALL living in the child's home (parents, step-parents, guardians, custodians, siblings, step-siblings, etc.)

Rows	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 NameLast Name
Employed?
Place of employment and work telephone number:
Did you work at this place of employment the full year in 2024?
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:
I verify that I DO NOT receive income of any kind

Mother's Income

Rows	$	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 NameLast Name
Employed?
Place of employment and work telephone number:
Did you work at this place of employment the full year in 2024?
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:
I verify that I DO NOT receive income of any kind

Father's Income

Rows	$	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.

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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
Chronic health condition doctor note

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Is your child currently receiving services for a developmental or educational need (Speech, OT, PT) ? If yes, submit copy of the documentation.
Developmental/education need documentation copy

If you selected yes that your child receives services, you must submit proof of documentation.
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Military status of parent/legal guardian
If your child is not in child care now, has he/she ever been in a child care program?
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?
Who currently cares for your child when you are at work or school?

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:
Who provides these services?
Does your child have an IEP
If yes, submit a copy of the IEP

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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

MonthDayYear
Date
Relationship to child.*IF legal guardian/custodian, court ordered documents must accompany; this application before it can be processed.
Court documents

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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
Kiddie Kare Too 704-982-9018 438 North Fourth Street, Albemarle, NC 28001
Little Friends Learning Center 704-983-6610 1210 Freeman Avenue, Albemarle, NC 28001
Love-N-Care II 704-982-1079 1302 Mountain Creek Road, Albemarle, NC 28001
Love-N-Care West 704-983-6416 534 Coble Avenue, Albemarle, NC 28001
Oakboro Kid's Club 704-485-8800 206 North Main Street, Oakboro, NC 28129
Quality Child Care 704-485-8821 219 East First Street, Oakboro, NC 28129
Richfield Child Development Center 704-850-4040 233 Culp Road, Richfield, NC 28137
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

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Child's immunization record

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Should be Empty:

NC Pre-K Enrollment Form

REQUIRED Income Verification

Family information

Family Responsibilities

Pre-K Sites

Document uploads