This form is for providers who are referring families to Preschool Promise for help with enrollment, or for parents/caregivers who are interested in Preschool Promise for their children.

Who is filling out this form?
Are you a…
Family info

Information about the parents or caregivers of the child who needs preschool enrollment.

Please fill out this information about yourself (the caregiver), and the child you wish to enroll in preschool.

Referring Provider/Organization info

This section is only for preschool provider staff. If you are a parent or caregiver, please fill out the “Family info” section above