2026-27 PA Pre-K Counts Application for Tiny Town Early Learning Center

PLEASE READ CAREFULLY!

Our PA Pre-K Counts provides FREE quality pre-school education for children ages 3 and 4 years of age who qualify financially for the program. (Please refer to the poverty guidelines as well as your residing school district’s cutoff date for Kindergarten.  Your child can only participate in the PKC program for 2 years.)

Your child is expected to attend the program Monday through Friday from 9AM-2PM. Wrap Around Care is available before these hours for an additional fee for families who require extended hours. The program operates on a 180-day schedule, consistent with local school districts. All absences must be documented and appropriate excuses provided in order for enrollment to continue.  

2026 Income Guidelines: In order to qualify, your total income must be at or below the following:

Family Size/Income Cap

1/$47,880

2/$64,920

3/$81,960

4/$99,000

5/$116,040

6/$133,080

7/$150,120

8/$167,160

Add $5,680 for each person in the household over 8 persons

Your child will be expected to attend Monday thru Friday, 9 AM-2 PM.  We offer care before 9 am and after 2 pm for a fee, for families that may need additional care.  We operate on a 180-day schedule just like our local school districts and absences must be accounted for and excuses provided in order to continue enrollment.

PLEASE EMAIL REQUIRED DOCUMENTS TO INFO@DUCKHOLLOW.NET AND IN THE SUBJECT LINE INCLUDE YOUR CHILD'S NAME, OR FEEL FREE TO DROP OFF PAPERWORK TO LINDSAY AT TINY TOWN EARLY LEARNING CENTER. 

YOUR APPLICATION WILL NOT BE PROCESSED WITHOUT ALL DOCUMENTATION.

1. Proof of Age: Child's State Issued Birth Certificate (front only)

2. Proof of Residency: Parent/Guardian Photo ID (must NOT be expired and have your current address. If in the process of updating address, please include the address change card.)

3. Proof of Income: We request your 2025 tax return, W-2's, or 3 CONSECUTIVE pay stubs.

Please include the following if it applies to you-Unemployment Compensation, Worker's Compensation, TANF Cash Payments, Social Security, SSI, Child Support, Alimony, etc.)

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Date of Application: *
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Child's Information:
Please carefully read and answer all questions concerning your CHILD in this section.
Child's First Name/Middle Initial/Last Name *
Gender *
Date of Birth *
MM
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DD
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Was your child born prematurely? *
If yes, how early?
Child's Social Security Number: *
Race: (Check all that apply) *
Required
Ethnicity (Check One): *
Required
Does your child have a verified disability with an active IFSP, IEP, or Behavior Plan? 
(If YES, please email it to info@duckhollow.net)
 *
Does your child have any identified developmental delays, or do you have concerns related to any of the areas listed below?  
(Check all that apply)
 *
Required
Does you child currently receive early intervention services? *
Does your child currently receive behavioral support? *
What school district do you live in? *
What elementary school your child will be attending *
My child will enter Kindergarten the year of: *
Does your child currently attend a childcare/preschool/head start facility? *
If yes, what is the name of the Center and how long did they attend?
Have you ever applied for Pre-K Counts for this child? *
Has your child or their sibling been enrolled in a Pre-K Counts or ITCS Program? *
Is your family part of the Welfare System? *
Is your child currently receiving ELRC? (Subsidized Child Care) *
Is your child in Foster Care, Kinship Care, or receiving Child Protective Services? *
Is one of the child's parents incarcerated or deceased? *
Is your child homeless? (living in a motel, shelter, or substandard housing?) *
Was the child's parent(s) less than 18 years of age when child was born? *
Did the child's parent complete high school or attain a GED? *
Does your child need wrap around care before 9AM and/or after 3PM? *
Please check all days that your child will need wrap around care.  *
Required
Child's Health Information
Health Insurance *
Member ID and/or Group #: *
Pediatrician's Name *
Pediatrician's Address *
Pediatrician's Telephone Number *
Allergies/Special Dietary Needs (if none indicate "None") *
Please indicate SNAP Number if Applicable (This number starts with a 26)
Household Information: 
Total Number of People living in the Household *
Number of Adults (over age 18) in the Household *
Number of Children (under age18) in the Household *
Total amount of income from all household members *
Do you have other children that you are interested in enrolling in our Center? (If YES, please indicate their name and date of birth) (If NO, indicate with a NO.) *
If you have English as a Second Lanuguage, please complete this section. Please indicate Language spoken at home. 
Parent/Guardian-1 Information:
Please carefully read and answer all questions concerning YOU, the applicant in this section.
First Name/Middle Initial/Last name *
Gender *
Relationship to Child (Check all that apply) *
Required
Date of Birth *
MM
/
DD
/
YYYY
Mailing Address *
Email Address *
Primary Phone Number *
Occupation and Place of Employment
Work Phone Number (if applicable)
Work Address (if applicable)
Employment Status (Check all that apply) *
Required
Parent/Guardian-2 Information (if applicable-if not, skip to next section)
Please carefully read and answer all questions concerning OTHER PARENT in this section.
First Name/Middle Initial/Last name *
Gender *
Relationship to Child: (Check all that apply) *
Required
Date of Birth *
MM
/
DD
/
YYYY
Mailing Address *
Email Address *
Primary Phone Number *
Occupation and Place of Employment
Work Address (if applicable)
Work Phone Number (if applicable)
Employment Status (Check all that apply) *
Required
Parents are:
(If you have a custody agreement, please email it to info@duckhollow.net)
 *
Check One: *
Relationship Information:
Emergency Contact & Authorized Pick Up Persons Only!
Do not include "Parent/Guardian 1 or 2" in this portion, as I already have your information. We need a minimum of 2 persons.
#1-First Name/Middle Initial/Last name *
Relationship to child *
Address *
Contact Number *
Check all that apply *
Required
#2-First Name/Middle Initial/Last name *
Relationship to child *
Address *
Contact Number *
Check all that apply *
Required
Family Assurances:

I understand that my child’s eligibility for Pennsylvania Pre-K Counts (PA PKC) is subject to the program’s two-year participation limit. My child must be at least three years old by the kindergarten cutoff date established by the public school district in which we reside in order to receive two years of participation. Once my child reaches the age required to enroll in kindergarten within our resident school district, I understand that they will no longer be eligible for PA PKC funding.

I understand that the PA PKC program is an educational program with required attendance expectations. I agree to ensure my child’s regular attendance and to notify the program in the event of any absences. The program’s hours of operation are 9AM-2PM.

I understand that once an enrollment date is confirmed, my child’s PA PKC enrollment status may be shared with OCDEL-funded programs, including the ELRC and Early Intervention (EI), to ensure appropriate coordination of funding and services.

To the best of my knowledge, all information provided in this application, including associated income documentation, is accurate and complete. I understand that I may be required to verify or provide proof of the information submitted. I certify that all information provided is true and accurate, and I understand that eligibility is subject to verification and that providing false information may result in disqualification.


In lieu of a written signature, I acknowledge that checking the box below serves as my electronic signature and authorizes the processing of this application. I understand that a written signature may be required at a later date. *
Required
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