Appendix C "Georgia's Pre-k Program Waiting List Information Form" - Georgia (United States)

What Is Appendix C?

This is a legal form that was released by the Georgia Department of Early Care and Learning - a government authority operating within Georgia (United States). As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on June 1, 2020;
  • The latest edition provided by the Georgia Department of Early Care and Learning;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a printable version of Appendix C by clicking the link below or browse more documents and templates provided by the Georgia Department of Early Care and Learning.

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Download Appendix C "Georgia's Pre-k Program Waiting List Information Form" - Georgia (United States)

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Georgia’s Pre-K Program
Please write the
Waiting List Information Form
school year in
the box
School Year
Clearly print the name as it appears on the Birth Certificate
Today’s Date (M/D/Y)
Last Name
| | | | | | | | |
| | | | | |
| | | | | | | | | |
First Name
| | | | | | | | |
| | | | | |
| | | | | | | | | |
Name Suffix (Jr, Sr, II, III)
| | | |
Date of Birth (M/D/Y)
Gender
Last 4 Digits of SSN
____/____/________
M
F
___ ___ ___ ___
Home Address
City
State
Zip
GA
County of Residence
Parent/Guardian Name
Preferred Phone Number
Additional Phone Number
Email Address
Preferred Method of Communication
Phone call:
Email:
Text message:
Cell phone number: ________________________________________
Information provided on this form is shared with Georgia Department of Early Care and Learning for the
purpose of maintaining a state level waiting list for Georgia’s Pre-K Program. By completing this form and
signing below you consent to the sharing of this information .
Parent/Guardian Signature
Date
Georgia’s Pre-K Program Operating Guidelines
Appendix C – revised 6/2020
Georgia’s Pre-K Program
Please write the
Waiting List Information Form
school year in
the box
School Year
Clearly print the name as it appears on the Birth Certificate
Today’s Date (M/D/Y)
Last Name
| | | | | | | | |
| | | | | |
| | | | | | | | | |
First Name
| | | | | | | | |
| | | | | |
| | | | | | | | | |
Name Suffix (Jr, Sr, II, III)
| | | |
Date of Birth (M/D/Y)
Gender
Last 4 Digits of SSN
____/____/________
M
F
___ ___ ___ ___
Home Address
City
State
Zip
GA
County of Residence
Parent/Guardian Name
Preferred Phone Number
Additional Phone Number
Email Address
Preferred Method of Communication
Phone call:
Email:
Text message:
Cell phone number: ________________________________________
Information provided on this form is shared with Georgia Department of Early Care and Learning for the
purpose of maintaining a state level waiting list for Georgia’s Pre-K Program. By completing this form and
signing below you consent to the sharing of this information .
Parent/Guardian Signature
Date
Georgia’s Pre-K Program Operating Guidelines
Appendix C – revised 6/2020