Funded Pre K Application

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Household Member #1


Household Member #2


Household Member #3


Household Member #4


Household Member #5


Household Member #6


Household Member #7


Household Member #8


Per PKC Statute, Regulations, and Guidance, the following members of the household are included in family size:

  • Parent of the child (biological or adoptive mother or father, stepmother or stepfather, caretaker or spouse)
  • A biological, adoptive, unrelated or foster child or stepchild of the parent or caretaker who is under 18 years of age and not emancipated.
  • A child who is 18 years of age or older but under 22 years of age who is enrolled in high school, a general educational development program, or a post-secondary program leading to a degree, diploma or certificate and who is wholly or partially dependent on the income of the parent or caretaker or spouse of the parent or caretaker.
  • Others supported by the income of the parent(s) or guardian(s) of the child enrolling or participating in the program. If counted toward family size, any applicable income of these persons must also be counted for eligibility purposes.
Note: A family size value of one (1) with an income of $0 is entered when a foster child is applying for Pennsylvania Pre-K Counts.

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Use the table below for definitions on each risk factor.
Risk Factor Definition
Preschooler with an Individualized Education Program (IEP)

Defined as a child who is currently enrolled in the Early Intervention program with an active IEP. Verification includes a copy of the IEP or other source of documentation from the parent or the Early Intervention agency.
Migratory (Non-Immigrant) Seasonal Student Defined as a child who has moved from one school district to another to accompany or join a parent or guardian who is a migratory agriculture worker or fisher within the preceding 36 months, in order to obtain temporary or seasonal employment in qualifying agricultural or fishing work, including agri-related businesses such as meat or vegetable processing, or work in nurseries such as Christmas and evergreen tree farming.
English Language Learner

Defined as a child whose first language is not English and who is in the process of learning English. Ask these two questions, as established by the Pennsylvania Department of Education, to determine if a child qualifies as an English language learner:

1) What is/was the child’s first language? 2) Does the child speak a language other than English? (Do not include languages learned in school). 
Homeless

If any of the situations below apply a family is eligible under McKinney-Vento. Additional guidance is available from the National Center for Homeless Education.


- If the family is staying with others, was this a result of a loss of housing, economic hardship, or other similar reason?

- Is the family living in a shelter? (Includes youth, emergency, transitional living, domestic violence, etc.)

- Is the family living in a motel, hotel, or campground?

- Is the family staying in a public or private place not ordinarily used as

a regular sleeping accommodation for human beings?

- Is the family living in cars, parks, public places, abandoned buildings, transportation stations, or similar settings?

- Is the family living in substandard (limited or no utilities, unsafe conditions, etc.) housing?

Has the child been abandoned, in a hospital, or awaiting foster care placement? 
Child in or Part of Family in Child Welfare System Defined as a child who is a foster child, a kinship care child, or receiving Children and Youth Services.
Child’s Family or Living Structure

Defined as a child with a single parent, divorced parents, or with relatives as guardians.
Child Receiving Behavioral Supports

Defined as a child who is referred to Pennsylvania Pre-K Counts from an appropriately credentialed health or mental health provider (not employed by the Pennsylvania Pre-K Counts program) or a child who is receiving mental health treatment. Additional verification beyond the interview is required.
Teen Parent Defined as a mother or father who was under the age of 18 when the child was born.
Incarcerated Parent Defined as a child for whom one or both of the child’s parents are currently incarcerated.
Education Level of Guardian

Defined as when the parent or legal guardian of the child does not have a high school diploma, high school equivalency, or postsecondary degree.
Eligible for or Receives the Following Public Assistance: TANF, SSI, SNAP This risk factor was added in 2024. Defined as a family who can produce documentation of eligibility for or receipt of TANF, SSI, or SNAP. (Categorically eligible for Head Start, please refer to HS program if available.)
Child Enrolled in Infant Toddler Contracted Slots Program (ITCSP)

Defined as a child enrolled in ITCSP and eligible to transition into PA PKC.
Child Lives in Geographic Area of High Poverty Providers wishing to prioritize specific geographic regions with higher rates of poverty may do so. This might include specific zip codes, school districts, or other factors.
Concerns Regarding Child’s Physical Development or Existing Medical Condition (Currently Not Receiving EI Services)

If a family concern is shared that is not covered by any of the other risk factors and the child has not yet been referred to EI for evaluation, the program should share information on EI.
Concerns Regarding Child’s Speech or Language Development (Currently Not Receiving EI Services)

If a family concern is shared that is not covered by any other risk factors and the child has not yet been referred to EI for evaluation, the program should share information on EI.
Concerns Regarding Child’s Social, Emotional, or Behavioral Development (Currently Not Receiving EI Services)

If a family concern is shared that is not covered by any other risk factors and the child has not yet been referred to EI for evaluation, the program should share information on EI.

  • 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 set by the school district where we live to assure compliance with receiving only two-years of PKC programming.
  • Once my child reaches the age required to enroll in kindergarten in the public school district where we live, I understand they will no longer be eligible for PA PKC funding.
  • I understand that my child’s enrollment is contingent upon meeting the eligibility criteria, including income verification and prioritization based on risk factors.
  • I understand that the PA Pre-K Counts (PKC) program is an educational program with attendance requirements. I agree to ensure my child’s regular attendance and to notify the program in case of absences.
  • I understand that the PKC portion of the day will be secular (non-religious) in nature and will not include religious instruction during the PKC portion of the day.





To the best of my knowledge, the information provided in this application and the associated income documentation is accurate. I understand that I may be asked to verify or give proof of information provided.I understand that eligibility is subject to verification and providing false information may result in disqualification.