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2020 - 2021 Hattiesburg Early Learning Collaborative Pre-K Application
Thank you for your interest in the Hattiesburg Early Collaborative Pre K program.

After you complete the following application, a member of the Hattiesburg Early Learning Collaborative (HELC) team will contact you to complete the registration process.
Email address *
Application Date: *
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School Zone (please select the zone in which the child lives): *
Child's Legal Name (first, middle, last): *
Preferred Name (optional):
Date of Birth: *
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Age: *
Race: *
Gender *
Street Address: *
City, State, Zip Code (ex: Hattiesburg, MS 39401): *
Parent/Guardian #1 (first and last name) *
Relationship to child: *
Cell Phone #: *
Other Phone #: *
Email Address: *
Is the parent/legal guardian an employee of Hattiesburg Public School District? *
If yes, which school or site?
Clear selection
Parent/Legal Guardian or Contact #2 *
Relationship to child: *
Cell Phone # *
Has the child ever attended PRVO Head Start? *
Has the child ever attended a childcare center? *
**I wish to apply for consideration for my child to attend the Hattiesburg Early Learning Collaborative Pre-K program. I understand that this form is an application only. The next step in the registration process will be a telephone interview. l further understand that I will be required to provide the following documents necessary for registration: birth certificate, social security card, immunization record, and two current proofs of residency. *
***By typing my full name below, I agree that all information included on this form is true and correct to the best of my knowledge and my full name serves as my electronic signature verifying such information. *
Today's Date: *
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