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
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
Child's physical home address
Child's mailing home address (mark N/A if not applicable)
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:
Monday, May 17, 2021
Tuesday, May 18, 2021
Wednesday, May 19, 2021
Thursday, May 20, 2021
Friday, May 21, 2021
Friday, June 18, 2021
Friday, July 30, 2021
Never submit passwords through Google Forms.
This form was created inside of Rockcastle County Schools.