Pre-K Application Form

Family/Guardian Information

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Parent/Guardian (primarily responsible for paying tuition fees if applicable)
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Would you like to submit information for an additional party responsible for paying tuition fees (optional)?

YesNo
Parent/Guardian (additional party responsible for paying tuition fees if applicable).
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email
example@example.com
My Household Size (Number of Family Members)*
Do you currently work for MCCSC?*

YesNo
Is this form being filled out with the intent of enrolling with an outside provider program?*

YesNo
Please select the provider from the dropdown menu below

Document Uploads

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Please upload each of the following documents as requested in the prompts below.

1) Two proofs of home address

2) Recent pay stubs

If you have any questions, or require assistance, please contact the Office of Early Learning and Out of School Programs:

Email: earlylearning@mccsc.edu

Phone: (812) 330-7702

Thank you!
Proof of Address (1)*

Cancelof
Proof of Address (2)*

(i.e. utility bill or lease with name, address, and date)
Cancelof
I am currently employed*

YesNo
Pay Stubs of Each Adult in the Household

Pay stubs should be for 60 days of pay history
Cancelof
Pay Stubs of Each Adult in the Household (additional upload if necessary)

Pay stubs should be for 60 days of pay history
Cancelof

Pre-K Application 2024-2025