Request a Provider Transfer

Select County *

Date *//

Parent Name *

First

Last

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email *

Employer *

Phone number to be reached *

Child's Name *

Birth date *//

Last date attended *//

Add a second child?

Current Provider *

Do you have a zero balance with your current provider? *

New Provider *

Address *

Address Line 1

Address Line 2

City

State

Zip Code

Effective date of transfer *//

Comment or Message

Message

PLEASE NOTE:

You will be contacted by phone regarding this transfer request, so please provide a current phone number where you can be reached.
The transfer request must be completed by parent/guardian receiving School Readiness services.
You should not complete this request for a Coalition Transfer.
In order to complete the transfer, you must log in to the Family Portal and provide an electronic signature when contacted by 4C.
You must have a zero balance with your current provider in order to transfer. This will be verified before your transfer request is processed.
You should speak to your new provider and verify that space is available for your child(ren) before requesting a transfer.
Transfers cannot be back-dated. Transfer requests received after 4 p.m. will be made effective the following business day as long as zero balance can be verified and an electronic signature is provided.
Transfer requests submitted on Saturday or Sunday will be processed on the following Monday.
Your new provider will receive your updated certificate through the Early Learning Provider Portal.