Head Start / ECEAP forms and documents

CCS HS/ECEAP/EHS Policy & Procedure Manual

Agreement form  CCS 97-141
Agreement form (West Boone Center) CCS 97-181 PDF | Word

Asthma plan and medication orders  CCS 97-165
Authorization to disclose and receive information  CCS 9713
Authorization to use identifiable nametags  CCS 97-157
Behavior incident report
  CCS 98-130
Behavior tracking report CCS 98-176
Blood lead-level handout 
CCS 98-137

C-Campis Programs child care discount application CCS 98-162
Child care exceptional fees 
CCS 9611
Child care programs application CCS 98-161 PDF | Word
Child development history 
CCS 98-122  PDF | Word
Child observation and individualized positive guidance plan  CCS 9901
Child Protective Services report  CCS 97-104  PDF | Word
Child care reimbursement voucher CCS 9853
Class observation report CCS 98-166
Classroom planning for a child with an IEP CCS 97-163
Classroom safety plan CCS 9625 PDF | Word
Classroom sign-up and sign-out log  CCS 9817
Confidentiality agreement  CCS 9879
Consent for screening, assessment and exchange of information  CCS 97-150

Continuing enrollment agreement  CCS 98-134
Controlled substance log CCS 98-175
Curriculum plan review and feedback CCS 98-169
Curriculum planning (Full day - part 1)  CCS 9891
Daily communication log CCS 9944

Dental examination record  CCS 9821
Directive regarding work hours, leave usage and work attendance CCS 98-160 PDF | Word
DST classroom/family documentation  CCS 98-133 PDFWord
DST family case management  CCS 9873

DST family documentation  CCS 98-132a
ECEAP forms and documents

Education activity submissions CCS 98-167
Education completion dates summary  CCS 9874
Education requirements tracking form CCS 98-168
Emergency action plan diabetest type I  CCS 97-164
Enrollment drop notification  CCS 9856  PDFWord

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
ERSEA Transfer request CCS 9941 PDF | Word
Exempt Head Start Staff attendance directive CCS 97-173
Family service coordinator (FSC) - new employee training documentation CCS 97-174 PDF | Word
Family strengths and partnership agreement/goals worksheet  CCS 98-129

Field trip permission (group)  CCS 9860
Field trip permission CCS 9862  PDF |Word
Field trip planning sheet  CCS 9844
Financial agreement  CCS 9610 PDF | Word

First-aid kit inventory checklist  CCS 9887
First-aid kit inventory checklist - kitchen CCS 98-112
Fluoride information handout  CCS 9846
Flouride information handout (Spanish)

Food request  CCS 97-121

Head injury letter CCS 97-182
Health concern CCS 98-109
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
Home visit planning & documentation CCS 9942 PDF | Word
Home visitor - new employee training documentation CCS 97-175 PDF | Word
Immunization due notice  CCS 9620
Immunization exclusion order CCS 9855

Infant/toddler child observation--double session/full day  CCS 9859  PDF | Word
Infant/toddler curriculum planning CCS 9861 PDF | Word

Infant/toddler daily staffing plan I  CCS 9864
Infant/toddler daily staffing plan II  CCS 9865
Infant/toddler progress record: Individualizing goals and objectives CCS 9867

In-home postpartum nursing assessment CCS 97-180 PDF | Word
Initial child development plans (CIP)

         I/T home-based  CCS 98-144
         I/T center-based  CCS 98-145
         PS  CCS 98-146
In-kind records
        Interagency meeting CCS 9840
Donation receipt  CCS 9794
Community volunteer  CCS 9795
Parent volunteer hours  CCS 9796
Interview committee recommendations  CCS 9899
Kindergarten transition checklist CCS 98-170 Pdf | Word
Language line usage CCS 98-171 PDF | Word
Late arrival/pick-up contract  CCS 98-120
Lead exposure risk  CCS 9897

Medication administration authorization  CCS 9896
Medication request form  CCS 97-160
Mental health consultant documentation  CCS 98-124
Mental health consultant information  CCS 97-112

Mental health consultant PIR log  CCS 98-125
Minor incident/accident/illness report  CCS 98-123
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

MUMPS Do Not Enter If...  (Sign)
New employee orientation checklist  CCS 98-136
New employee and PIR information CCS 9900
New hire orientation checklist - full time CCS 98-165
Notice of privacy (English)  CCS 98-121
Notice of privacy (Spanish)  CCS 98-147

Nutrition CACFP infant meal form CCS 98-179
Nutrition daily infant meal record CCS 98-180 PDF
Nutrition diet request: Food allergy/Intolerance  CCS 98-141 PDF | Word
Nutrition diet request: Menu adaptations  CCS 98-157 PDF | Word
Nutrition Food allergy/intolerance prescription CCS 98-155
Nutrition infant meal record: birth - 5 months CCS 98-181
Nutrition medical disability statement for food substitution(s)  
CCS 98-158
Nutrition request for fluid milk substitution  CCS 98-154  PDF | Word
Part day teacher - new employee training documentation CCS 97-176 PDF | Word
Parent information: medications at HS/EHS  CCS 97-158
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
Postcard (one)  CCS 9624  PDF | Word
Postcard (four) CCS 9624  PDF | Word
Practical dress guidelines for early childhood classroom and work environments CCS 98-143

Pre-employment health exam  CCS 98-110
Pre-employment health exam instructions  CCS 98-118
Pre-employment payment voucher CCS 97-184
Pregnancy enrollment information  CCS 9622  PDF | Word
Prenatal home visit planning & documentation CCS 9943
Preschool classroom management reflective checklist CCS 97-179
Preschool curriculum planning (Double sessions - part 1)  CCS 9893

Preschool readiness checklist  CCS 97-178
Records request  CCS 98-128
Release of information-Holmes  CCS 9902

Release of information-Woodridge  CCS 9947
Release and emergency treatment authorization  CCS 9828
Request for volunteer vendor number  CCS 98-142

Seizure health care plan  CCS 97-166
Seizure observation log  CCS 97-162
Sensory/growth screening results  CCS 9824
Severe allergy reaction plan & medication orders  CCS 97-167
Severe allergies guidelines  CCS 97-161
Special diet letter  CCS 98-140

Special services summary CCS 98-159 PDF | Word
Standards of conduct agreement  CCS 9878
Table of contents: Child/family file (CENTER)  CCS 98-139
Table of contents: Child/family file (HOME)  CCS 98-138

Teacher - New employee training documentation CCS 97-177
Topical treatment permission and application log  CCS 9810  PDF | Word
Training log  CCS 9939 
Training request-parent  CCS 9890

Training/travel request-staff  CCS 98-102
Transfer/transition notes  CCS 98-149  PDF | Word
Transition plan checklist  CCS 98-135
USDA child and adult care food program  CCS 98-103
Waiting list update  CCS 9857  PDF | Word
Weekly in-kind home learning plan for Home Base  CCS 98-152

Well-child examination record  CCS 9822
WIC information request  CCS 9757  PDF  |  Word document