Enrollment Application

 
 
 Welcome! 

 
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We are so pleased you are considering CenClear for your child!

All of the information in this document will be treated confidentially by CenClear staff. This form is being completed on a secure site.

Applying to CenClear's programs does not guarantee acceptance. CenClear's Head Start and PA PreK Counts programs are state and federally-funded and do have income eligibility requirements. Prior to the child being accepted into the program, the family income must be verified by CenClear staff. Once the application is submitted, you will be contacted by a CenClear staff member to let you know if your child may qualify for the program, to discuss the next step and to answer any questions you may have.


   
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I understand my typed signature carries the same weight as my written signature.
 
   
  Thank you for submitting this application! Next you will be contacted by a CenClear staff member to let you know if your child may be eligible for a CenClear program. If it is determined your child is eligible for a CenClear program, financial information will have to be submitted. All of the following information that applies to you will need to be submitted:
* Income information from your 1040-A tax form
* W-2 forms
* Pay Stub
* Social Security information for you and your child
* Your Access Number
* Earned Income Number Amount
* Veteran's Benefits Amount
* Social Security Benefits Amount
* Unemployment Compensation Amount
* Public/Cash Assistance Amount
* Supplemental Income Amount
* Alimony Amount
* Child Support Amount
* Workmen's Compensation Amount
* Financial Assistance or Education Amount
* Income received on behalf of a foster child
* Any other information needed to determine your gross income

If you need assistance applying for CenClear's Early Childhood programs or have any questions please call 1-800-525-5437.
   
 
 
 
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