Home : IEL Forms : Head Start

Head Start / ECEAP forms and documents

Agreement form  CCS 97-141
Application
Asthma plan and medication orders  CCS 97-165
Attendance concern notification  CCS 9858  PDF | Word 
Authorization to disclose and receive information 
CCS 9713
Authorization to use identifiable nametags  CCS 97-157
Behavior incident report
  CCS 98-130
Blood lead-level handout  CCS 98-137
CACFP parent/guardian request for fluid milk substitution 
CCS 98-154  PDF | Word
Child care exceptional fees 
CCS 9611
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
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
Curriculum planning (Full day - part 1)  CCS 9891
Daily communication log CCS 9944
Declaration of no income  CCS 9848
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
Early achievers: Request for family interviews  CCS 9626
ECEAP forms and documents
Education completion dates summary  CCS 9874
Eligibility vertification  CCS 9621
Emergency action plan diabetest type I  CCS 97-164
Enrollment drop notification  CCS 9856  PDFWord
Enrollment eligibility priority point checklist  CCS 98-126  PDF | Word
Exempt Head Start Staff attendance directive CCS 97-173
Family housing questionnaire CCS 9940 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
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 allergy/intolerance information  CCS 98-155
Food request  CCS 97-121

Health concern CCS 98-109
Health, dental and diet history  CCS 98-116
Health requirements reminder  CCS 9888
Health screening information for parents  CCS 9823
Home visit planning & documentation CCS 9942 PDF | Word
Immunization due notice  CCS 9620
Immunization exclusion order CCS 9855
Initial child development plans (CIP)
         I/T home-based  CCS 98-144
         I/T center-based  CCS 98-145
         PS  CCS 98-146
Infant daily meal record for birth - 7 months  CCS 97-170 PDF | Word
Infant daily meal record for 8 - 11 months  CCS 97-171 PDF | Word
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-kind records
       
Interagency meeting CCS 9840
       
Donation receipt  CCS 9794
       
Community volunteer  CCS 9795
       
Parent volunteer hours  CCS 9796
Interview committee recommendations  CCS 9899
Late arrival/pick-up contract  CCS 98-102
Lead exposure risk  CCS 9897
Medical disability statement for food substitution(s)  CCS 98-158
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
Milk allergy intolerance information  CCS 98-104
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
New employee orientation checklist  CCS 98-136
New employee and PIR information CCS 9900
Notice of privacy (English)  CCS 98-121
Notice of privacy (Spanish)  CCS 98-147
Parent information: medications at HS/EHS  CCS 97-158
Parent participation sign-in sheet  CCS 9885
PIR volunteer services information  CCS 9880
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 medical exam  CCS 98-110
Pre-employment medical exam instructions  CCS 98-118
Pregnancy enrollment information  CCS 9622  PDF | Word
Prenatal home visit planning & documentation CCS 9943
Preschool curriculum planning (Double sessions - part 1)  CCS 9893
Records request  CCS 98-128
Release of information-Holmes  CCS 9902
Release of information-Logan  CCS 9883
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 diet request: Food allergy/Intolerance  CCS 98-141 PDF | Word
Special diet request: Menu adaptations  CCS 98-157 PDF | Word
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
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 request CCS 9941 PDF | Word
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
Working Connections child care authorization to disclose and receive information CCS 97-168