Forms and Information

 

SITE REPORT 2017-2018

ANNUAL REQUIRED TRAINING – PDF

Click here for presentation: Annual Required Training

ACTIVE SUPERVISION

 

ATTENDANCE

 

CLASSROOM CHECKLISTS

 

CHILD PLUS

CLI CIRCLE PROGRESS MONITORING

CLI REPORTS:

 

DECA/e-DECA

DISABILITY

 FAMILY/COMMUNITY INFORMATION

HEALTH

 

IN-KIND

 

MENTAL HEALTH

 

PARENT MEETING INFORMATION

SUBSTITUTE/VOLUNTEER INFORMATION

 

CHILD FILE FORMS

ERSEA Information

 

2017-2018 Child File Checklist

2017-2018 HS Income Guidelines

Application Checklist

Application Cover Sheet – ENGLISH / SPANISH

2017-2018 Head Start Emergency Card (blue card)

Section 1

Enrollment Table of Contents

Inspection of Confidential Records

Change of Status *

Child Plus Application forms ENGLISH pg 1 pg 2

SPANISH pg 1 pg 2

Head Start Eligibility Verification

Applicant Eligibility & Enrollment Info. / Individual Systematic Selection Form

Income Source documentation: one or more of the following:

Homeless Verification form

No Income Verification form

   Tax Return, Check Stubs, W-2, etc.

Notification letter *

Acknowledgement of Parent Handbook signature form

Copy of birth certificate

Copy of Social --Security card

Copy of photo ID

Proof of Residency

Legal Documents*

Optional/Other Forms (district forms)*

 

Section 2

Health Table of Contents

Consent for Head Start Services ENGLISH – SPANISH

Health Coverage Form / Copy of Insurance

Child Health History ENGLISH – SPANISH

Child Nutrition Assessment ENGLISH – SPANISH

Release of Information-Dental ENGLISH – SPANISH

Dental Examination form

Release of Information-Physical ENGLISH – SPANISH

Physical Examination form

Head Start / WIC Permission for Release and Exchange of Information ENGLISH – SPANISH

Hemoglobin/Hematocrit  results

Lead results

Hearing and Vision Results -or- screener ENGLISH – SPANISH

Immunization record

Risk Assessment for Lead Exposure: Parent Questionnaire

Tuberculosis – Parent Questionnaire ENGLISH – SPANISH

Child Plus Growth Charts (weight for stature) end of year summary (CP3410)

In House Referral *

Accident Report *

Optional/Other Forms*

Denial of Service form

 

Section 3

Social Services Table of Contents

Progress Notes

Center-based Family Partnership Agreement ENGLISH – SPANISH

FPA Goals and Outcomes Assessment

Head Start Family Goals

In House Referral *

Permission for Release and Exchange of Information * ENGLISH – SPANISH

Optional/Other Forms*

 

Section 4

Parent Involvement Table of Contents

Parent Education and Interest Questionnaire ENGLISH – SPANISH

Parent Communication Log

Child Tardy / Attendance Logs

Attendance Documentation/Referral

Notes from parent/guardian *

Tardy/Absent Acknowledgement *

Tardy/Absent Notification Letter *

Need for Transportation/Enrollment*

Optional/Other Forms*

Section 5

Education Table of Contents

DIAL 4

DIAL 4 Parent Questionnaire

DECA Report

Head Start Work Sample 

Anecdotal Notes – filed at the end of the year

CLI Progress Monitoring Reports –Wave 1,2,and 3

Home Visit/ Parent Conference form –filed at the end of the year

Transition Plan 

Field Trip Permission forms

In House Referral *

Optional/Other Forms*

 

 

Section 6

Mental Health Table of Contents

Parental Consent for Mental Health/Behavioral Services ENGLISH – SPANISH

Progress Notes *

In House Referral *

Individual Mental Health Observations*

Individual Positive Guidance Plan/follow up *

Permission for Release and Exchange of Information * ENGLISH – SPANISH

Optional/Other Forms*

 

Section 7

Special Education Table of Contents

In House Referral *

IFSP/IEP/Secion 504 Plans or Disclaimer*

Parent Permission *

SST documentation *

Optional/Other Forms*