Texas School Ready!™

Instructions: Please fill out the information below. If you require support with this form, contact Bang Pham at (713) 500-3699 or email: bang.n.pham@uth.tmc.edu.If you have questions regarding the content of this form, please contact us at 1-800-315-7204 (toll-free) or email: TexasSchoolReady@uth.tmc.edu

Type of Participant   Returning ParticipantNew Participant
Name of Facility  

Name of Director/Principal  

Type of Program  
Licensed Child Care Head Start School District Pre-K

TEEM Status
TEEM NON-TEEM Unsure


# of 4 yr old Classrooms

# of Combination 3-4 yr old Classrooms

Nearest Community/City  
Amarillo Austin Beaumont Beaumont Nederland Belton Brazoria Brownsville Copperas Cove/Ft. Hood Crystal City/Pearsall Dallas El Paso Ellis County ESC 12 - Waco ESC 14 - Abilene ESC 17 - Lubbock ESC 18 - Midland/Odessa ESC 7 - Kilgore/Tyler ESC2 - Corpus Christi/Kingsville Fort Worth Galveston Houston Huntsville Killeen La Joya La Marque/Hitchcock Lampasas Laredo LaSara/Raymondville McAllen NE Texas San Angelo San Angelo (Brownwood) San Angelo (Mason) San Antonio Stockdale Temple Victoria WSS Tri-County/ Ft Bend Other

Address 1

Address 2

City

State

Zip Code

Phone Number  

Alternate Phone

Email Address  
Check the box below if you have reviewed the document "Learning About the School Readiness Certification System Application " prior to submitting this request.