2025-2026 NC Pre-K Application for Stokes County

2025-2026 NC Pre-K Application for Stokes County

NC Pre-Kindergarten Services Information
- NC Pre-K classrooms operate at least six and a half hours a day, Monday through Friday, from early August - late May.
- NC Pre-K classes are located in the Stokes County School System, Head Start, and private child care centers.
- Different sites may have different eligibility requirements.
- By submitting an application, you will be considered for all possible placements.
- The program is free to qualifying families.
- Space is limited and some children may be placed on a wait list.
Should I Apply?

If one or more of the following guidelines is true for you or your child, you may qualify for NC Pre-K services:
- Child must turn four years of age on or before August 31, 2025 to be considered for the upcoming 2025-2026 school year;
- Household income meets limit of 75% State Median Income or less (receives priority);
- Family (of 8 or less) receiving Public Assistance (WIC, Medicaid, Food Stamps, Public Housing, TANF/Work First, SSI, SNAP);
- Eligible military family;
- Identified disability;
- Developmental/educational need based on developmental screening tool;
- Diagnosed chronic health condition having potential to interfere with development/learning as determined by medical
  professional;
- Limited English-speaking skills;
- Living in foster care or kinship care;
- Experiencing homelessness;
- Receiving refugee services.
Completing this application does not guarantee participation in the NC Pre-K program.

Parent/Guardian will be notified in writing of their child's eligibility/enrollment status in July 2025.

Required Documents
Required Documents

Children's Health Report Dental Screening

Applications are incomplete without the following documentation:
1. Verification of birth (Birth Certificate, Medical Records, Immunization Record)
2. Verification of gross, annual household income (tax form 1040 or W-2 or 4 consecutive paystubs, Social Security benefits, Child Support, etc.)
  OR
  Verification of Public Assistance (WIC, Medicaid, Food Stamps, Public Housing, TANF/Work First, SSI, SNAP)
3. Verification of Residency (copy of utility bill, rental agreement, drivers license, etc.)
4. Documentation of custody/guardianship if child does not live with biological parent
5. Individualized Education Plan (IEP) or Section 504 plan if applicable
*If your child is enrolled you must submit a recent (exam in past 12 months) health assessment including dental, vision and hearing screenings completed and signed by your child’s medical provider.

Submit Required Documents
- Upload Files Now: If you are completing the online application, you may upload the required documents at the end of this application.
- Upload Files Later: If you have submitted the online application form, you will receive an email with your application reponses and a link to return to the application to make edits. When you visit this link, you will be able to return to your child's application to upload the documents at the end of the form.
- Email Files: Required documents may be emailed to: scox@stokespfc.com
- Mail/Drop Off Files: You may also deliver the required documents to:
  Stokes Partnership for Children
  PO Box 2319
  151 Jefferson Church Rd, Suite 104
  King, NC 27021
Applications will not be processed until all required documents have been submitted.

Pre-K Site Preferences

Information About Locations for Pre-K Sites

Children are assigned to sites by the Pre-K staff; however, it would be helpful for us to know which sites would be convenient for you. Some sites are open to all applicants and some sites are limited to children who meet certain criteria. Children will be assigned to a site based on eligibility, residency, needs of the family, and requirements of the program.

Site	Address	Phone	Director/Principal
King Elementary	152 East School St, King, 27021	336-983-5824	Katherine Thrower
London Head Start	609 School St, Walnut Cove, 27052	336-591-7340	Rhonda Wrenn
Mt. Olive Elementary Preschool	2145 Chestnut Grove Rd King, NC 27021	336-983-4351	Matthew Richardson
Mt. Olive Head Start	2145 Chestnut Grove Rd, King, 27021	336-367-4993	Rhonda Wrenn
New Life Center*	415 Summit St, Walnut Cove, 27052	336-591-3109	Chris Graves
Pinnacle Elementary	1095 Surry Line Rd, Pinnacle, 27043	336-368-2990	Susan Sprinkle
Sandy Ridge Head Start	1308 Amostown Rd, Sandy Ridge, 27046	336-871-2551	Rhonda Wrenn
Walnut Cove Elementary	1211 Walnut Cove Rd, Walnut Cove 27046	336-591-4408	Daniel Bryant

Transportation is not offered at any Pre-K location.

*Extended Care Offered at New Life Center only (Limited Availability)

In order to help us with placement decisions, please let us know which site(s) might best meet your needs. Please indicate your 1st, 2nd, and 3rd choices below.*

	Site Name
1st Choice
2nd Choice
3rd Choice

Do you have another child enrolled at any of the sites that have a NC Pre-K classroom?*

YesNo
If so, which one?

Family Information
Who does the child live with?*

Mother and FatherSingle MotherSingle FatherParent and Step Parent (Legally Married)50/50 Joint CustodyGrandparent(s)Foster Parent(s)Legal GuardianOther
Does your family have a stable living arrangement?*

YesNoPrefer not to answer (please explain)
Mother/Stepmother/Guardian Name*

First NameLast Name
Resides with child?*

YesNo

Contact Information*

	Phone Number
Cell Phone #
Home Phone #
Work Phone #

Father/Stepfather/Guardian Name*

First NameLast Name
Resides with child?*

YesNo

Contact Information

	Phone Number
Cell Phone #
Home Phone #
Work Phone #

Email Address*
The best email address to reach you at
If you wish to opt out of receiving SPC's e-newsletter, initial here

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What is the child's family size? (Total number including the Pre-K child)*

Please list the names of ALL family members that live in the household*

	Full Name	Relationship to NC Pre-K Child	Date of Birth
1
2
3
4
5
6
7

Are the parents in this household employed or enrolled in school? Check all that apply.

Mother/Guardian*

	Yes	No	Full-Time	Part-Time
Working
Seeking Employment
In School

Employer name
School Name

Father/Guardian

	Yes	No	Full-Time	Part-Time
Working
Seeking Employment
In School

Employer name
School Name
Please select the highest level of education completed
Mother/Guardian*
Father/Guardian
LIST ALL SOURCES OF INCOME IN THE CHILD'S HOUSEHOLD

Mother/Stepmother/Guardian's Income*

	Amount	Frequency
Earned Income/OT
Social Security
SSA
SSI
Unemployment Benefits/Worker's Comp
Child Support/Alimony

Other Support

	Select any that apply
Public Housing
TANF/Work First
WIC
Food Stamps/SNAP
Medicaid for Child

Father/Stepfather/Guardian's Income*

	Amount	Frequency
Earned Income/OT
Social Security
SSA
SSI
Unemployment Benefits/Worker's Comp
Child Support/Alimony

Other Support

	Select any that apply
Public Housing
TANF/Work First
WIC
Food Stamps/SNAP
Medicaid for Child

If you are currently unemployed, and are not receiving unemployment benefits or other source of regular income, please list the person or source that provides support for this family
I certify this information is true. If any part is false, I understand my child's participation in the program may be terminated.
Parent/Guardian Signature (Type First and Last Name)*
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
Other Information
Is parent/legal guardian of this child an active member of the military, or was a parent or legal guardian of this child injured or killed while on active duty? (Verification of military documentation required)*

YesNo
Since birth, has this child ever been enrolled in a preschool, child care center, or home day care?*

YesNo
Is child currently enrolled in a preschool, child care center, or home day care?*

YesNo
If currently enrolled, what is the name of the program?
Is your child receiving subsidy for child care?*

YesNoOn subsidy waiting list
Does your child have a chronic health condition? (Documentation from physician required)*

YesNo
If yes, what is the health condition?
Does your child need assistance with potty training?*

YesNo
Has your child been diagnosed with a Special Need?*

YesNo
If yes, does your child have Individualized Education Plan (IEP) or a Section 504 plan?

YesNo
Is your child currently receiving services for a special need or disability?*

YesNo

If yes, please specify (check all that apply and list the service provider)

	Check All That Apply	Service Provider
Speech
Physical Therapy
Educational Services
Mental Health
Occupational Therapy
Identified Disability

If Identified Disability, please specify
How did you hear about us?*
Parent Responsibility and Participation
- I understand this is an application for services offered and does not constitute enrollment into any program.
- I certify that the information given on this application is true and accurate and all income has been reported.
- I understand this information is being given for receipt of federal and/or state funds. Officials may verify the information on this application. Deliberate misrepresentation of the information may subject me to prosecution under applicable federal and/or state laws.
- The information on this form may be used only in the determination of eligibility for the Head Start, Title I and/or NC Pre-K programs. I hereby release the information so that my child may be considered for either program. The designated agencies may share and/or verify any and all information regarding my child.
- I understand that if my child is selected in the NCPK program, parent involvement will be critical to the success of my child and I/we commit to participate as required by the program criteria.
- I understand that regular, on time attendance is expected to allow teachers to support my child's learning and readiness for kindergarten.
- I understand I am responsible for providing transportation for my child if transportation is not available at my child's school.
- I give permission for my child to receive developmental, hearing, vision, dental and/or speech and language screening and for the results to be shared with partnering Pre-K programs (Head Start, Title I, and NC Pre-K).
- I understand I am required to provide my child's up to date immunization records and physical/dental exam form completed by a medical provider on the first day of school.
Parent/Guardian Signature (Type First and Last Name)*
Parent/Guardian Signature*

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Date*

MonthDayYear
Date
Submit Required Documents

See list of required documents under the "Required Documents" section that is located at the top of this application.
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