Welcome to Greene Lamp, where we provide a safe, supportive, and vibrant educational environment for children aged 1 to 5 years and their parents. Our comprehensive program addresses all areas of a child’s development: physical, mental, social, and emotional. Children and families receive a broad range of educational, nutritional, preventive health, and social services. We engage caregivers and children to address educational needs in a way that promotes long-term family sustainability. Our goal is to foster a lifelong love for learning for each of the children we serve. Please complete this form to begin the pre-screening process. Read and answer each question that is applicable to your family. All fields marked with an asterisk (*) are required.

Parent/Guardian

Please answer questions about education, employment and income based on the date of the application. For teen parents, only enter "Yes" if 18 years or YOUNGER on the date of application.

Address

You must provide your current living address. If the living address is different from the mailing address, provide the secondary address in the mailing address section. Greene Lamp is unable to accept a P.O. Box as your living address.
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Additional Parent/Guardian

Only complete this section if the Secondary Adult is currently living in the home, being supported by the same income, and related by blood, marriage, or adoption; or are the child’s authorized caregiver or legally responsible party.

Other Adults

Are there other adults in the household?

Add Another Adult

Family Information

Include all persons living in the same household who are supported by the child’s parent(s)’ or guardian(s)’ income; and are related to the child’s parent(s) or guardian(s) by blood, marriage, or adoption; or are the child’s authorized caregiver or legally responsible party.

Emergency Contacts

Child (Applicant)

Answer all required questions for the child/children you are submitting the application. If your child has an IEP or IFSP, chronic condition like asthma, diabetes, seizures, allergies, dietary restrictions please enter the details in the notes at the end of the application. Be sure to upload supporting documents in the upload attachments section.

Location Preferences
- Your Address - Available Locations
Click a location on the map to see more info
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Additional Applicant

Do you want to apply now for another child in your family?

Add Another Applicant

Siblings

Are there other children in the family?

Add a Sibling
After selecting "Save and Continue," you will be directed to the "Upload Document" screen. Here, please scan or take a picture of the required documents using your cell phone, computer, or laptop. Once you have captured the documents, proceed to upload them by following the on-screen instructions. After uploading the necessary documents, click on "Save and Continue" to complete the process. If you encounter any issues or have questions, please don't hesitate to contact us for assistance.: If you have any questions about information that needs to be submitted, please contact us at 252-523-7770 and select "option 0" for the operator to transfer your call to a Family Advocate. Required Documents: > Proof of income for the last 12 months (W-2, 1040 income tax form, or pay stubs) >Proof of any additional income Public Assistance (TANF, SNAP, child support, SSI, etc.) >Birth Certificate >State or federal ID of parent/guardian (if applicable) >Insurance Card (Medicaid/Private Insurance etc) Thank you for your cooperation.
Required information is missing, see above.