Form Oel Vpk 02 – Fill Out and Use This PDF

I. Child Certificate of Eligibility is issued by Early Learning Coalition, through the Family Portal: 1. VPK program year, 2. Certificate number, 3. Certificate issue date and 4. Parent email address.

5. Parent name, 6. Primary contact number and 7. Secondary contact number.

8. Child's full name, 9. Child's date of birth and 10. County.

II. Admission by Provider or School is jointly prepared by the provider or school and the parent or guardian.

Enter 11. Name of provider or school and 12. Telephone.

Enter 13. Address of VPK site, 14. VPK class and 15. Date child will begin attendance.

The provider or school certifies that it admits the child (item 8) for enrollment in the VPK Program and agrees to deliver the minimum instructional hours to the child.

Provider or school: sign 16. Signature of authorized representative for provider or school; enter 17. Date.

By signing 18. Parent signature, you certify that you choose the provider or school (item 11) to deliver the VPK Program for your child and direct that program funds be paid to the provider or school for your child; enter 19. Date.

A private provider or public school must keep each original signed form for at least 5 years from the date of the last payment for that fiscal year or until the resolution of any related audit findings or any related litigation, whichever occurs last. A private provider or public school must permit the early learning coalition to inspect the original signed forms during normal business hours. If required by the early learning coalition, a signed copy of this certificate must be forwarded to the coalition or a qualified contractor acting on behalf of the coalition.