Question Form: NC Pre-K

Please complete the form below to request more information.

Information collected on this form, including personal information, will be used to help inform our team on how best to serve you and your family and for statistical data purposes. Personal data is subject to our Privacy Policy.

CONTACT INFORMATION

First Name

Last Name

Preferred Phone Number

Email Address

Message

TOTAL number of children/dependents (include infants, children, and any adult dependents)

Please use this section of the form to record information about each of your children/dependents.  Enter details below about a child/dependent and, if needed, use the "Add another response" link in the lower right part of this page to add information about another child/dependent.  Repeat as needed. 

HOUSEHOLD MEMBER INFORMATION

Child/Dependent's First Name

Child/Dependent's Last Name

Date of Birth