Preschool Screening Sign-up Form
YOUR CHILD MAY QUALIFY IF:
-- He/She is a Campbell County Schools resident and...
-- He/She is 3 or 4 years old and displays difficulty in speech and/or problems attaining developmental skills that are needed to be successful in school
-- He/She is 4 years old by August 1st and the family qualifies financially

After submitting this form a letter will be mailed with date/time/location your child is scheduled to be screened

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Child's Last Name *
Child's First Name *
Child's Birthday *
MM
/
DD
/
YYYY
Address: Street, City and Zip *
IF you have a PO Box Address - Enter it here
Parent / Guardian: First Name *
Parent / Guardian: Last Name *
Parent / Guardian: Phone *
Parent / Guardian: Email *
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