Pre-Kindergarten Transition Intent Form

Your child will be turning three-years old soon! To prepare for your child’s transition into a pre-kindergarten program, it is important to understand your intent regarding how your child’s on-going care will be funded.

Child's Name(Required)

Child's DOB(Required)

MM slash DD slash YYYY

Location(Required)

Choose a LocationDowntown YMCAEastside YMCAThe Y at Early Learning CenterThe Y at Early Learning University

Please check the statement that applies:(Required)

We are ONLY interested in Child Care Subsidy (eligibility will be determined by ELRC). We are not interested in Pennsylvania PreK Counts.

We are ONLY interested in Pennsylvania PreK Counts (eligibility and enrollment will be determined by the PKC program and will occur based on program’s school year recruitment timeline). We are not interested in Child Care Subsidy.

We are interested in BOTH Child Care Subsidy (eligibility will be determined by ELRC) AND Pennsylvania PreK Counts (eligibility and enrollment be determined by the PKC program and will occur based on program’s school year recruitment timeline).

We are NOT interested in EITHER Child Care Subsidy OR Pennsylvania PreK Counts.

Parent/Guardian Name(Required)

Parent/Guardian Email(Required)

Parent/Guardian Signature(Required)

Date(Required)

MM slash DD slash YYYY