Head Start
PRE-KINDERGARTEN SERVICES INFORMATION 2024-2025
Please keep this page for your information
What is Pre-Kindergarten?
The NC Pre-K Program is designed to provide high-quality educational experiences to enhance school readiness for eligible four-year-old children.
The NC Pre-K Program Requirements are built on the National Education Goals Panel’s premise that to be successful academically in school,
children need to be prepared in all five of the developmental domains that are critical to children’s overall well-being and success in reading and
math as they enter school:
• Approaches to Play and Learning
• Emotional and Social Development
• Health and Physical Development
• Language Development and Communication
• Cognitive Development
The NC Pre-K Program Requirements are designed to ensure that a high-quality pre-kindergarten classroom experience is provided for eligible four-
year-old children in each local NC Pre-K Program and that, to the extent possible, uniformity exists across the state. Programs are also required to
meet the NC Child Care Rules. NC’s Pre-K program meets several nationally accepted benchmarks for measuring quality early learning. These
include comprehensive Early Learning Standards; staff who are required to meet education/licensure requirements, professional development; 1:10
staff/child ratio; developmental screens and referral; evidence-based curriculum and formative assessments; monitoring and nutritional requirements.
Should I apply?
If one or more of the following guidelines is true for you or your child, you may qualify for Pre-Kindergarten services:
• Child must turn four years of age on or before August 31, 2024, to be considered for the upcoming 2024-2025 school year;
• Child resides in a household with a low-income or receiving public assistance;
• Children of certain military families;
• Child with an identified disability or developmental/educational need;
• Child with a chronic health condition;
• Child/family with limited English proficiency;
• Children experiencing homelessness;
• Children receiving refugee services;
• Child living with a foster family, legal guardian, or relative;
• Three-year-old children may qualify under the Head Start program and be three on or before August 31, 2024.
What you will need to apply:
Completed Application
Proof of Age
Medical Records or Immunization Records are accepted for private site/Head Start placements.
Proof of income (1040, W-2, Child Support, Social Security, Retirement, Disability, Unemployment Benefits,
Workers Compensation, Public Assistance/Work First Benefits, SNAP, Military pay, or 3 consecutive paystubs).
Each parent or guardian that is not employed or does not have a regular source of income will be required to complete a statement regarding no
income and list the source of support for the family. (See boxes on second page of application).
Proof of Residency (current utility bill or rental agreement)
If applicable, proof of foster care, proof of receiving refugee services, proof of WIC, proof of Public Housing, proof of TANF/Work First, proof of
Medicaid, proof of SSI, proof of Food and Nutrition Services (Food Stamps) SNAP
*Once enrolled, additional documents will be required for ABSS Pre-K Students (Birth Certificate or Verification of Facts, 2 current proofs of
address, and Parent's ID)
If interested in applying, please return the application and supporting documents to one of the sites listed below. Completing this application
does not guarantee participation in the NC Pre-Kindergarten program.
Alamance Partnership for
Children
2322 River Road
Burlington, NC 27217
Phone: 336 513-0063 ext. 105
Fax: 336 226-1152
4-year-old applications only
Alamance Burlington School
System
Ray Street Complex
609 Ray Street, Graham, NC
27253
Phone: 336-438-4212
Fax: 336-570-6353
4-year-old applications only
Head Start Junction
421 Alamance Road
Burlington, NC 27215
Phone: 336-436-0202
Accepts 3 & 4-year-old
applications
Janice S Scarborough Head
Start
615 Gunn Street
Burlington, NC 27217
Phone: 336-226-5558
Accepts 3 & 4-year-old
applications
ALAMANCE COUNTY PRE-KINDERGARTEN SITES *Please note sites are subject to change.
Location
Address
School
Uniforms
Arrival
Dismissal
Before/After Care
Transportation
1. Alexander Wilson Elementary
2518 NC 54
Graham, NC 27253
NO
7:50
2:30
NO
NO
2. Audrey Garrett Elementary
3224 Old Hillsborough Road
Mebane, NC 27302
NO
7:50
2:30
NO
NO
3. Andrews Elementary
2630 Buckingham Road
Burlington, NC 27217
NO
7:50
2:30
NO
NO
4. Eastlawn Elementary
502 N. Graham-Hopedale Rd
Burlington, NC 27217
NO
7:50
2:30
NO
NO
5. EM Yoder Elementary
301 N. Charles Street
Mebane, NC 27302
NO
7:50
2:30
NO
NO
6. Grove Park Elementary
141 Trail One
Burlington, NC 27215
NO
7:50
2:30
NO
NO
7. Haw River Elementary
701 E. Main Street
Haw River, NC 27258
NO
7:50
2:30
NO
NO
8. Hillcrest Elementary
1714 West Davis Street
Burlington, NC 27215
NO
7:50
2:30
NO
NO
9. Newlin Elementary
316 Carden Street
Burlington, NC 27215
NO
7:50
2:30
NO
NO
10. North Graham Elementary
1025 Trollinger Road
Graham, NC 27253
NO
7:50
2:30
NO
NO
11. Smith Elementary
2235 Delaney Drive
Burlington, NC 27215
NO
7:50
2:30
NO
NO
12. South Graham Elementary
320 Ivey Road
Graham, NC 27253
NO
7:50
2:30
NO
NO
13. Sylvan Elementary
7718 Sylvan Road
Snow Camp, NC 27349
NO
7:50
2:30
NO
NO
14. Beginning Visions CDC
145 Huffine St.
Gibsonville, NC 27249
NO
7:45
2:45
Yes, before and after-school
care is offered at $100/week
NO
15. Childcare Network 78B
100 E. Hanover Rd.
Graham, NC 27253
NO
7:45
2:45
Yes, before and after-school
care is offered at $75/week
NO
16. Creative Childcare
3216 NC Hwy 54 East
Graham, NC 27253
NO
7:45
2:30
Yes, before and after-school
care is offered at $85/week
NO
17. Creative Childcare 2
2257 NC 87 South
Graham, NC 27253
NO
7:45
2:30
Yes, before and after-school
care is offered at $85/week
NO
18. Excel Christian Academy
825 Apple St.
Burlington, NC 27217
YES
8:30
3:00
Yes, before and after-school
care is offered at $100/week.
Before care only is
$80/week
NO
19. JSS Head Start
Accepts 3 and 4-year-old children
615 Gunn St.
Burlington, NC 27217
NO
8:00
2:30
Before and after-school care
is available. Must have a
DSS subsidy voucher for
payment
TBD
20. Head Start Junction
Accepts 3 and 4-year-old children
421 Alamance Rd.
Burlington, NC 27215
NO
8:00
2:30
NO
TBD
21. Graham Head Start
Accepts 3 and 4-year-old children
600 Ray St.
Graham, NC 27253
NO
8:00
2:30
NO
TBD
22. Positive Day School
229 N Graham Hopedale Rd.
Burlington, NC 27217
YES
8:00
2:30
NO
NO
23. Kool Kidz Place
1824 E Webb Ave
Burlington, NC 27217
NO
8:00
2:30
NO
NO
1) 1)n Elementar
Head Start
2024-2025 Pre-Kindergarten Application for Alamance County
Please indicate your 3 site choices in order of preference.
1
st
Choice ___________________________ 2
nd
Choice ____________________________ 3
rd
Choice ______________________________
CHILD’S INFORMATION
Child’s name_______________________________________________________________________________ Date of Birth________________________
First Middle Last
Child’s Home Address_____________________________________________________________________________________________________________
Street City State Zip
Mailing Address____________________________________________________________________________________________________________________
If different from above Street City State Zip
American Indian or Alaska Native Asian Black or African American
Native Hawaiian or Other Pacific Islander Hispanic/Latino White or European American
g
Gender Male Female
Is the child an Alamance County resident? Yes No
What is the primary language spoken in your home? English Spanish Other (Specify): ______________________
What language does your child speak most often? English Spanish Other (Specify): ______________________
FAMILY INFORMATION
Who does the child live with?
Mother and Father Mother Father Parent & Stepparent Joint Custody
Grandparent(s) Foster parent(s) Legal Guardian* Legal Custodian* Kinship Provider**
Other (Specify): ____________________
*Attach copies of legal documentation
**Note: Kinship is the self-defined relationship between two or more people and is based on biological, legal, and/or strong family-like
ties. For the purposes of NC Pre-K, kinship is established when the child lives with and is cared for by an adult who is not the child’s
parent, legal guardian, legal custodian, or foster parent.
Does your family currently have a stable living arrangement?
Yes No Prefer not to answer (please explain) ________________________________________________
Parent/Guardian 1 _________________________________________________________________ Resides w/child YES NO
Home Phone Number __________________________ Cell Phone _____________________________
Email address: ________________________________________________________________________________________________
Parent/Guardian 2 _________________________________________________________________ Resides w/child YES NO
Home Phone Number __________________________ Cell Phone _____________________________
Email address: ________________________________________________________________________________________________
How many family members live in the household (including the NC Pre-K Child)? _________
Please list the names of ALL family members that
live in the household.
Relationship to the NC
Pre-K Child
Date of Birth
Where do siblings attend school?
1.
2.
3.
4.
5.
6.
OTHER INFORMATION
• Is the parent/legal guardian of this child an active member of the military, or was a parent or legal guardian YES NO
of this child injured or killed while on active duty? (Verification of military documentation required)
• Since birth, has this child ever been enrolled in a preschool, child care center, or home day care? YES NO
• Is the child currently enrolled in a preschool, child care center, or home day care? YES NO
If currently enrolled, what is the name of the program? ____________________________________
• Is your child receiving subsidies for child care? YES NO If no, on the subsidy wait list? YES NO
• Does your child have a chronic health condition? (Documentation from physician required) YES NO
If yes, what is the health condition? ___________________________________________________
• Does your child need assistance with potty training? YES NO
• Has your child been identified or referred for a Special Need? YES NO
• If yes, does the child have an Individualized Education Plan (IEP) or an Individualized YES NO
Family Services Plan (IFSP)?
• Is your child currently receiving services for a special need or disability? YES NO
If yes, please specify (check all that apply)
Speech Physical Therapy Educational Services Autism Developmental Delay
Mental Health Identified disability- Please specify __________________________________
• Tell us how you heard about the NC Pre-K Program ________________________________________________________
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 any of the
above-mentioned programs. The designated agencies may share and/or verify all information regarding my child.
• I understand that if my child is selected to participate 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 I am responsible for providing transportation for my child.
• 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 authorize the Alamance Partnership for Children, Alamance-Burlington School System (ABSS), and Head Start
at Head Start Junction and JSS Head Start to use the information in this application for the purpose of
determining eligibility for state and federally funded Pre-K programs and for data collection and program
evaluation by the NC Division of Child Development and Early Education (DCDEE).
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 the receipt of services provided by state and federal funding. Officials may verify the information on
this application. Deliberate misrepresentation may result in the removal of my child from the program.
Parent/Guardian Signature _____________________________________________ Date ____________________________
*PLEASE COMPLETE INCOME VERIFICATION FOR YOUR APPLICATION TO BE FINALIZED*
VERIFICATION OF INCOME
Child’s Name: ______________________________________________ D.O.B: ______________________
Are the parent(s)/guardian(s) in this family employed or enrolled in school? Please check.
Parent/Guardian 1: Employed YES NO Employer name: _____________________________ F/T P/T
Seeking Employment YES NO
Enrolled In School YES NO School name: _____________________________
Parent/Guardian 2: Employed YES NO Employer name: _____________________________ F/T P/T
Seeking Employment YES NO
Enrolled In School YES NO School name: _____________________________
Please check the highest level of education completed:
Parent/Guardian 1:
Not completed High School High School Diploma/GED Attended some college Associate Degree Bachelor’s Degree
Master’s Degree Doctorate Degree
Parent/Guardian 2:
Not completed High School High School Diploma/GED Attended some college Associate Degree Bachelor’s Degree
Master’s Degree Doctorate Degree
Parent/Guardian 1 Income - LIST ALL SOURCES OF INCOME (Please provide documentation)
Employment Income $___________ weekly every two weeks twice a month monthly annually
Public Assistance/Work First $____________ weekly every two weeks twice a month monthly annually
Social Security/SSA/SSI $____________ weekly every two weeks twice a month monthly annually
Unemployment Benefits/Worker’s Comp $__________ weekly every two weeks twice a month monthly annually
Child Support/Alimony $______________ weekly every two weeks twice a month monthly annually
Other (Specify)______________$___________ weekly every two weeks twice a month monthly annually
Parent/Guardian 2 Income -LIST ALL SOURCES OF INCOME (Please provide documentation)
Employment Income $____________ weekly every two weeks twice a month monthly annually
Public Assistance/Work First $____________ weekly every two weeks twice a month monthly annually
Social Security/SSA/SSI $____________ weekly every two weeks twice a month monthly annually
Unemployment Benefits/Worker’s Comp $__________weekly every two weeks twice a month monthly annually
Child Support/Alimony $____________ weekly every two weeks twice a month monthly annually
Other (Specify) ___________$____________ weekly every two weeks twice a month monthly annually
Parent/Guardian Signature ____________________________________________________ Date ________________________
* * *CONTRACT ADMINISTRATOR USE ONLY* * *
Received By: Date Received: Date Processed: Processed By:
Head Start
CERTIFICATION OF NO INCOME
This form is to be completed by each parent or legal guardian, residing in the household, and claiming no income from any source.
Child’s Name: ______________________________________________ D.O.B: ______________________
How do you support yourself?
Are you receiving assistance from any of the following resources:
o Food and Nutrition Services (SNAP or Food Stamps)
o Medicaid
o Public Housing
o WIC
o Other: ___________________________________
I hereby certify that I do not individually receive income from any of the following sources:
a. Wages from employment (including commissions, tips, bonuses, fees, etc.);
b. Income from operation of a business;
c. Social Security (SSA), Supplemental Security Income (SSI);
d. Rental income from real or personal property;
e. Annuities, retirement, pensions, or death benefits;
f. Unemployment or disability payments;
g. Public assistance (Work First/ Cash Assistance);
h. Child support or Alimony;
i. Sales from self-employment (Avon, Mary Kay, Lawn Mowing, etc.);
j. Any other source not named above.
Choose one:
I have no income of any kind and while I am seeking employment, there is no definite job offer currently.
I have no income of any kind and I will not be seeking employment at this time.
Parent/Guardian 1:
I (Parent/Guardian) _______________________________________declare that I have no income of any kind, earned or unearned and that
the information above is complete and accurate. By signing this form, I certify that the information provided above is true. I understand that
providing false information may impact my child’s NC Pre-K eligibility or enrollment.
_______________________________________ __________________________
Parent/Legal Guardian Signature Date
Parent/Guardian 2:
I (Parent/Guardian) _______________________________________declare that I have no income of any kind, earned or unearned and that
the information above is complete and accurate. By signing this form, I certify that the information provided above is true. I understand that
providing false information may impact my child’s NC Pre-K eligibility or enrollment.
_______________________________________ __________________________
Parent/Legal Guardian Signature Date
_______________________________________ __________________________
Staff Signature Date
