2026-27 PA Pre-K Counts Application - English 1.16.26

  • 2026-2027 PreK Counts Application

  • Date*
     - -
  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Child Date of Birth*
     - -
  • Age of Child at Start of Program Year (By Sept. 1, 2026)*
  • Gender*
  • Race*
  • Ethnicity*
  • Primary Language*
  • Parent Gender*
  • Relationship to Child*
  • Select*
  • Role*

  • Per PKC Statute, Regulations, and Guidance, the following members of the household are included in family size:

    ·         Parent of the child (biological or adoptive mother or father, stepmother or stepfather, caretaker or spouse)

    ·         A biological, adoptive, unrelated or foster child or stepchild of the parent or caretaker who is under 18 years of age and not emancipated.

    ·         A child who is 18 years of age or older but under 22 years of age who is enrolled in high school, a general educational development program, or a post-secondary program leading to a degree, diploma or certificate and who is wholly or partially dependent on the income of the parent or caretaker or spouse of the parent or caretaker.

    ·         Others supported by the income of the parent(s) or guardian(s) of the child enrolling or participating in the program. If counted toward family size, any applicable income of these persons must also be counted for eligibility purposes.

     

    Note: A family size value of one (1) with an income of $0 is entered when a foster child is applying for Pennsylvania Pre-K Counts.

  • Rows
  • Employment Status of Parent/Guardian*
  • Employment Status of 2nd Parent/Guardian*
  • Household Income Sources (check all that apply)*

  • Enrollment Priority Criteria (Must check all that apply):

    These indicators help us learn more about your family and understand what supports may be helpful. Your answers also help us determine enrollment priority so we can serve families with the greatest need first. Every family’s situation is unique, and all information is kept confidential.

  • Risk Factors (Select all that Apply)*
  • Family Assurances (Please select each to acknowledge and agree to the following:*

  • Parent/Guardian Certification

    To the best of my knowledge, the information provided in this application and the associated income documentation is accurate. I understand that I may be asked to verify or give proof of information provided.

    I certify that all information provided is accurate. I understand that eligibility is subject to verification and providing false information may result in disqualification.

  • Date*
     - -
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