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Head Start Forms

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
  • Pandemic agreement form CCS 97-187
  • 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
  • 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
  • Community enrollment agreement CCS 97-186 PDF | Word
  • 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 9846
  • 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

Child smiling with two front teeth