This Knowledge Document provides an overview and final evaluation report of the Children's Defense Fund Southern Regional Office's (CDF-SRO) Gateway to Kindergarten Readiness (GTKR) initiative. This initiative sought to build upon earlier successful CDF-SRO kindergarten readiness initiatives by increasing capacity for systems alignment between private child care, Head Start, and public schools while integrating and aligning health assessments and services. Over the course of the initiative the CDF-SRO served as a coordinator and convener to recruit a cohort of three-year-old students, screen those students using best-practice academic and health instruments, and administer developmentally appropriate interventions and refer students for health care when indicated based on screening results. Throughout the program, CDF-SRO leaders and GTKR staff updated the program design and work plan based onthe changing context and lessons learned from formative evaluation results. A late-stage impacting factor on the initiative was the onset of COVID-19 in the first quarter of 2020.