All forms are stored in PDF format unless indicated the type of format. Forms are categorized by Department/Program. (Updated Feb. 2021)

Family Services

Enrollment Packets

• Head Start Folder Format
• Confidentiality Form
• Language Assessment
• Early Learning Behavior
• PFCE Family Goal Assessment
• Family Partnership Agreement Plan
• Family Serve Home Visit Form
• Operational Policies and Procedures Manual Confirmation Form
• Parent Interest Survey
• 2020-21 Parent Survey for Services (Traditional, Hybrid, or Virtual)

Transition Packet

• Transition Packet

Application Forms

• Statement of Information Regarding Family Situation
• Outer Agency Referral Form

Personal Identifiable Information (PII)

• Notice Regarding PII – English
• Consent to Disclose PII Form – English
• Notice Regarding PII – Spanish
• Consent to Disclose PII Form – Spanish

Transfer Form

• Instructions and Procedures
• Head Start Program Transfer Form
• Early Head Start Program Transfer Form

Withdrawal Form

• Instructions and Procedures
• Head Start Program Withdrawal Form
• Early Head Start Program Withdrawal Form

Center Forms

• Attendance Improvement Plan
• PIR Addendum
• Waiting List Notice
• Notice of Acceptance

Parent Involvement

• PC Meeting – Announcement
• PC Meeting – Agenda
• PC Meeting – Sign In Roster
• PC Meeting – Presenter Agenda
• PC Meeting – Minuets (English & Spanish)
• Treasure’s Report
• Change of Meeting Date
• Donation Letter Request Form
• Fundraising Clearance Report
• Project Request
• Training Activity Log

HSPC

• Officers Information Sheet
• Parent Committee Officers
• Policy Council Members

Early Head Start

• Early Head Start Folder Format
• Early Head Start Hearing Screening
• Early Head Start Vision Screening
• Permission Form – Insect Repellant
• Permission Form – Nature Walk
• Head Start-Early Head Start Health Summary
• Infant Care Instructions
• Infant Needs and Service Plan

Children Health Services

Health Record Booklet

• Completed Health Record Booklet (All Forms)
• Form 1 – General Information
• Form 2A – Health History
• Form 2B – Health History
• Form 3 – Physical Examination Assessment
• Form 5 – Dental Health
• Form 6 – Nutrition
• Form 9 – Psychological and Social Development
• Form 10 – Staff Observation of Health and Behavior

Mental Health

• Mental Health Questionnaire (Ages Birth-2 Years)
• Mental Health Questionnaire (Ages 3-9 Years)
• Mental Health Referral Packet (For Referral Use Only)