South Carroll VPK Enrollment Form
Hello and Welcome to the Voluntary Pre-Kindergarten informational page and application.  Thank you for your interest!  Clarksburg School is currently awaiting state funding, determined by the Tennessee Department of Education, for Voluntary Pre-K.  Once the state releases its grant recipients, Clarksburg School will know the status of its VPK program.  Please complete the application below to be considered.

Please complete the form below for the 2022-2023 VPK application.  Required fields are marked with an *.
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Email *
Today's Date *
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Child's  FIRST Name
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Childs MIDDLE Name
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Child's LAST Name
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Child's Date of Birth
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Home Address
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Parent Name(s)
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Primary Phone Number
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Primary Email
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Does your child have an Individualized Education Plan (IEP) or 504? 
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Required
Has your child ever been enrolled in a Tennessee school?
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Is the above listed address a shelter or temporary living situation?
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Has your child received early intervention services in the home or at a center?
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Does your child receive any of the following services?
Please select all that apply.
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Required
Do you have speech concerns for your child?
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Total number of family members residing in household.
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Family Status
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Employment Status of 1st Parent
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Employment Status of 2nd Parent
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Gross Monthly Household Income
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Are you currently receiving WIC?
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Emergency Contact #1.
Please enter as follows:  Last Name, First Name, Phone Number.
 *
Emergency Contact #2. 
Please enter as follows:  Last Name, First Name, Phone Number.
 *
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