Your earnings must be less than 300% of poverty. Attach proof of income to this application. (See chart linked above for amounts based on family size.) If you are eligible for a slot with Pre-K Counts, it will be required that you provide income documentation such as paystubs, W-2, or 1040 tax forms.

The information you have provided will be evaluated and applicants will be ranked according to the needs assessment criteria pre-determined by Pre-K Counts guidelines. We will then contact you with information regarding your eligibility and/or selection into the program. For those who have qualified for the program, a visit and orientation will be scheduled to explain the program and paperwork necessary to start your child on the road to school readiness.

Checking the box above indicates that you acknowledge and agree to the following:
• My child’s eligibility for Pennsylvania Pre-K Counts (PA PKC) is subject to the program’s two-year participation limit. My child must be at least three years old by the kindergarten cutoff date set by the school district where we live to assure compliance with receiving only two years of PKC programming.
• Once my child reaches the age required to enroll in kindergarten in the public school district where we live, I understand they will no longer be eligible for PA PKC funding.
• My child’s enrollment is contingent upon meeting the eligibility criteria, including income verification and prioritization based on risk factors.
• The PA PKC Program is an educational program with attendance requirements. I agree to ensure my child’s regular attendance and to notify the program in case of absences. My program’s PA PKC hours of operation will be somewhere between the hours of 8am and 2pm.
• The PKC portion of the day will be secular (non-religious) in nature and will not include religious instruction during the PKC portion of the day. My program’s PA PKC hours of operation will be somewhere between the hours of 8am and 2pm.
• I understand the guidelines outlined above and I have answered all questions honestly and to the best of my ability.
• I give permission for appropriate information to be shared with the holders of the grant in order to complete the terms within the grant relative to statistics and tracking of Early Childhood practices.
• To the best of my knowledge, the information provided is accurate. I understand that I may be asked to verify or substantiate information provided.
• I understand that if my child is eligible for Head Start, I will be informed and provided with information about my options. And, I may still choose to enroll in the Pre-K Counts program.