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Early Head Start & Head Start Program Forms and Informational Handouts


Program Forms - Fillable and Printable Forms

Program forms listed below are either fillable (F) or printable (P) as indicated at the end of each form name.
There are two category of forms:  Child/Family Forms & Staff Related Forms

Child and Family Program Forms
Behavior Tracking Tool (F/P)
Bus Evacuation Drill Report (F)
Bus Attendance and Tracking (MS Excel Document) (P)
Case Management (F)
Child Abuse and Neglect Report Form (F) - ST. LOUIS COUNTY Report Child Abuse LINK
Children's Dental Service (CDS) Consent Form (P)
CACFP - Breakfast Menu (F)
CACFP - CACFP Site Monitoring - Five Day Reconciliation Form (F)
CACFP - Child and Adult Care Food Program (CACFP) Enrollment Form (P)
CACFP - Field Trip Food Record (F)
CACFP - Food Temperature Log (F)
CACFP - Lunch Menu (F)
CACFP - Milk Substitution (P)
CACFP - Snack Menu (F)
Child and Family Signature Tracking (P) 
Child Referral - Child Referral Form (CRF) (F)
Child Referral - Child Modified Schedule (F)
Child Referral - Mental Health Consultant Services (F)
Daily Sign In/Out Form (P)
Disposition of Medication (P)
Field Trip and Event (F)
Fire and Tornado Drill Log (P)
Getting to Know Your Child and Family (P)
Immunization Exemption Form (MN Dept. of Health) (P)
Lesson Plan - Preschool - 4 Day Classrooms (F)
Lesson Plan - Media Use Template (F)
Lesson Plan - Small Group Activity Template (F)
Lesson Plan - Distance Learning (F)
MARRS (MN Early Childhood Registration Form) (P)
Minneapolis Preschool Screening Instrument (For RESCREEN ONLY) (P)
Pathway I Scholarship Application (F)
Pathway II Scholarship Application (F)
SEAM - Infant Family Profile SEAM (F)
SEAM - Toddler Family Profile SEAM (F)
SEAM - Preschool Family Profile SEAM (F)
Separation Report (P)
Sign In/Out - Non Parents Form (P)
Socialization Form (P)
Strengths & Difficulties Questionnaire (SDQ) (F)

Staff Forms:
Bloodborne Exposure Medical Exam Declination for Staff (Blood Borne Exposure Form) (P)
Employee Emergency Contact Form (F) 
Employee Health Exam Form (P)
Employee Hepatitis B Vaccination Form (Blood Borne Exposure Form) (F)
Material Requisition Request Form (F) - Click here for the Head Start: Inventory Catalog (P)
Paid Time Off (PTO) Pay Out (P)
Post Exposure Medical Evaluation(Blood Borne Exposure Form) (P)
Staff Emergency Information (F)
Staff In Service Training Record (DHS-4679-ENG) (F)

 

In Kind Monthly "At Home Activity" Forms.

Health Alert Notice Forms

 

October is National Head Start and Early Head Start Awareness Month!

  hs awareness month pic

 On October 22, 1982, President Ronald Reagan proclaimed October as Head Start Awareness Month.  Thirty-nine years after the proclamation, his words still inspire.   His words demonstrate why in 1995 the first Early Head Start grant was awared to expand and serve low-income pregnant women and children birth to 3.   In 1998, the Head Start program was reauthorized to expand to full-day and full-year services.   

"The National Head Start Program has helped over eight million low-income pre-school children and their families. In so doing, it has earned recognition and support for its success in early childhood education and development.  Perhaps the most significant factor in the success of Head Start has been the involvement of parents, volunteers, and the community. Their commitment and the services provided by dedicated Head Start staff have been instrumental in creating a quality program that truly provides young children with a “head start” in life.”  - President Ronald Reagan

Thank you to all our dedicated Early Head Start & Head Start staff who help improve and enrich so many children's lives!

Visit the National Head Start Association (NHSA) website for more information about Early Head Start & Head Start!

 
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