MVES - PRESCHOOL Screening Appointment Form
The purpose of this form is to request a screening appointment for your Preschool aged child. Please be sure to select school that is within your residential boundaries to attend.
PLEASE BRING THE FOLLOWING TO YOUR CHILD'S SCREENING APPOINTMENT:
Proof of income (REQUIRED)
Child's birth certificate (if available)
Social security card
Physical, dental & vision exam documentation
Immunization record
Legal documentation/proof of custody/Power of Attorney (if applicable)

*We understand that because of COVID-19 and the CDC Guidelines, obtaining medical records may prove to be difficult. Rockcastle County Schools will be flexible in the timeline of submitting those medical specific requirements. HOWEVER, the proof of income is required.
Child's full legal name (First, Middle, Last) *
Child's date of birth *
MM
/
DD
/
YYYY
Parent/Guardian Name(s) *
Child's physical home address *
Child's mailing home address (mark N/A if not applicable) *
Phone number *
Do you have any concerns with your child's development? (i.e. speech/language concerns, developmental delay, motor skills, cognitive, etc.) *
Please select a screening appointment date: *
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