Head Start Forms

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Head Start - Administrative

Confidentiality agreement CCS 9879
Directive regarding work hours, leave usage and work attendance CCS 98-160 PDF | Word
Exempt Head Start Staff attendance directive CCS 97-173
Family service coordinator (FSC) - new employee training documentation CCS 97-174 PDF | Word
Head Start Model Release Form CCS 1858 PDF | Word
Home visitor - new employee training documentation CCS 97-175 PDF | Word
Interview committee recommendations CCS 9899
Practical dress guidelines for early childhood classroom and work environments CCS 98-143
Pre-employment medical exam CCS 98-110
Pre-employment medical exam instructions CCS 98-118
Standards of conduct agreement CCS 9878
Teacher - New employee training documentation CCS 97-177
Training request-parent CCS 9890
Training/travel request-staff CCS 98-102

Head Start - Disabilities/Mental Health

Classroom planning for a child with an IEP CCS 97-163
Mental health consultant documentation CCS 98-124
Mental health consultant information CCS 97-112
Mental health consultant PIR log CCS 98-125
Special services summary CCS 98-159 PDF | Word

Head Start - Education

Behavior incident report CCS 98-130
Behavior tracking report CCS 98-176
Child development history CCS 98-122
Child protective services report CCS 97-104 PDF | Word
Classroom safety plan CCS 9625 PDF | Word
Classroom sign-up and sign-out log CCS 9817
Curriculum plan review and feedback CCS 98-169
Education activity submissions CCS 98-167
Field trip permission (group) CCS 9860
Field trip permission CCS 9862
Field trip planning sheet CCS 9844
Infant/toddler daily staffing plan I CCS 9864
Kindergarten transition checklist CCS 98-170 PDF | Word

Head Start - ERSEA

Agreement form CCS 97-141
Agreement form (West Boone Center) CCS 97-181 PDF | Word
Application CCS 9847
Authorization to disclose and receive information CCS 9713
Enrollment drop notification CCS 9856 PDF | Word
ERSEA Annual income worksheet CCS 98-173
ERSEA Attendance action plan CCS 98-163 PDF | Word
ERSEA Attendance letter CCS 9858 PDF | Word
ERSEA Declaration of no income CCS 9848 PDF | Word
ERSEA Eligibility verification CCS 9621 PDF | Word
ERSEA Family housing survey CCS 9940 PDF | Word
ERSEA Final attendance notification CCS 98-172 PDF | Word
ERSEA Priority Point checklist CCS 98-126 PDF | Word
Postcard (one) CCS 9624 PDF | Word
Postcard (four) CCS 9624 PDF | Word
Transition plan checklist CCS 98-135
Transfer Request CCS 9941 PDF | Word
Transfer/transition notes CCS 98-149

Head Start - Family Services

Consent for screening, assessment and exchange of information CCS 97-150
DST classroom/family documentation CCS 98-133
DST family case management CCS 9873
DST family documentation CCS 98-132
Family strengths and partnership agreement/goals worksheet CCS 98-129
Language line usage CCS 98-171 PDF | Word
Late arrival/pick-up contract CCS 98-120
Notice of privacy (English) CCS 98-121
Notice of privacy (Spanish) CCS 98-14
Parent interest survey CCS 98-178
Parent participation sign-in sheet CCS 9885
PIR volunteer services information CCS 9880
Policy council child care information form CCS 98-174
Records request CCS 98-128
Table of contents: Child/family file (CENTER) CCS 98-139
Waiting list update CCS 9857

Head Start - Fiscal/Child Care

C-CAMPIS Programs child care discount application CCS 98-162
Child care exceptional fees CCS 9611
Child care reimbursement voucher CCS 9853
Continuing enrollment agreement CCS 98-134
Financial agreement CCS 9610 PDF | Word
Request for volunteer vendor number CCS 98-142

Head Start - Health and Safety

Asthma plan and medication orders CCS 97-165
Blood lead-level handout CCS 98-137
Classroom safety plan CCS 9625 PDF | Word
Controlled substance log CCS 98-175
Dental examination record CCS 9821
Emergency action plan diabetes type I CCS 97-164
First-aid kit inventory checklist CCS 9887
First-aid kit inventory checklist - kitchen CCS 98-112
Fluoride information handout CCS ccs-9846
Fluoride information handout (Spanish) CCS 9 846
Health concern CCS 98-109
Head injury letter CCS 97-182
Health, dental and diet history (ECEAP) CCS 97-155
Health, dental and diet history (EHS) CCS 98-116
Health requirements reminder CCS 9888
Health screening information for parents CCS 9823
Immunization due notice CCS 9620
Immunization exclusion order CCS 9855
Lead exposure risk CCS 9897
Medication administration authorization CCS 9896
Medication request form CCS 97-160
Minor incident/accident/illness report CCS 98-123
MUMPS Do Not Enter If... (Sign)
Parent information: medications at HS/EHS CCS 97-158
Release and emergency treatment authorization CCS 9828
Seizure health care plan CCS 97-166
Seizure observation log CCS 97-162
Severe allergy reaction plan & medication orders CCS 97-167
Severe allergies guidelines CCS 97-161
Topical treatment permission and application log CCS 9810 PDF | Word
Well-child examination record CCS 9822

Head Start - Home Visiting

In-home postpartum nursing assessment CCS 97-180 PDF | Word
Initial child development plans (CIP)
I/T home-based CCS 98-144
Pregnancy enrollment information CCS 9622
Pregnancy planning and documentation CCS 9943
Table of contents: Child/family file (HOME) CCS 98-138

Head Start - In-Kind

Community volunteer CCS 9795
Donation receipt CCS 9794
In-kind individual parent volunteer time form CCS 97-185 PDF | Word
In-kind recordsiInteragency meeting CCS 9840
Monthly in-kind home learning plan - infant/toddler CCS 98-153 PDF | Word
Monthly in-kind home learning plan - preschool CCS 98-151 PDF | Word
Parent volunteer hours CCS 9796 PDF | Word

Head Start - Nutrition

Food request CCS 97-121
Nutrition CACFP infant meal form CCS 98-179
Nutrition daily infant meal record CCS 98-180
Nutrition diet request: Food allergy/Intolerance CCS 98-141 PDF | Word
Nutrition diet request: Menu adaptations CCS 98-157 PDF | Word
Nutrition infant meal record: birth - 5 months CCS 98-181
Nutrition request for fluid milk substitution CCS 98-154 PDF | Word
Request for special dietary accommodations CCS 98-183 PDF | Word
Special diet letter CCS 98-140
USDA child and adult care food program CCS 98-103
WIC information request CCS 9757

Head Start - Parent Co-op Forms

Child observation and individualized positive guidance plan CCS 9901
Curriculum plan review and feedback CCS 98-182
Daily communication log CCS 9944
ERSEA Family housing survey CCS 9940 PDF | Word
ERSEA Transfer request CCS 9941 PDF | Word
Home visit planning & documentation CCS 9942 PDF | Word
Immunization due notice CCS 9620
Prenatal home visit planning & documentation CCS 9943
New employee and PIR information CCS 9900
Release of information-Holmes CCS 9902
Release of information-Woodridge CCS 9947
Training log CCS 9939

Head Start/ECEAP