Pre-K Enrollment Application 2024-2025
Please complete and submit this form in its entirety. If the child does not live with birth parents, please include guardian information and income.

If you have any questions related to the required information, please call Michelle Martin at 276-730-3218 or email her at emmartin@ccpsd.k12.va.us .
Completing this form is only the beginning of the application process. Once completed, and we have received the supporting documentation, you will receive notification of acceptance status by early June.
Child's First Name *
Child's Middle Name *
Child's Last Name *
Child's Birth Date *
Please enter the date in this pattern MM/DD/YYYY
Child's Gender *
Is this child potty trained? *
Does the child have an IEP?
Check all that apply
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