Consistent with the first of the National Educational Goals 1990 (to ensure that all children in America will start school ready to learn by the year 2000), South Carolina initiated the Pre-School Health Appraisal Project (PSHAP), a collaborative practice model based on the experiences of 4 years of project development and findings. Initiated in 1988 and funded by the state, the project was tasked with providing pre-school comprehensive health appraisals for children prior to their entrance into first grade. Appraisals were conducted by public health nurses, nurse practitioners, and school nurses at the school site. The service was offered to all children at no cost; parents were encouraged to be present; conditions and problems were identified; referrals were made to the private sector; payment sources for care included Medicaid, self-pay, and health insurance; referral outcomes were monitored; and parents were educated to care for minor health conditions in their children. Data tables and charts are included in the paper. Appendices, which comprise about three-quarters of the paper, provide PSHAP forms, home treatment letters, information on school and health district responsibilities, confidential parent questionnaire, coordinators' instructions, maps of school districts eligible for PSHAP, and a list of selected PSHAP participating school districts in PSHAP year 4. (LL)