Your earnings must be less than 300% of poverty. Attach proof of income to this application. (See chart below 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 I understand the guidelines outlined above and that I have answered all questions honestly and to the best of my ability. My signature also indicates that 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.

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.

To the best of my knowledge, the information provided is accurate. I understand that I may be asked to verify or substantiate information provided.