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 ERSEA Forms Index

 

Recruitment

Annual Recruitment Plan - fillable

Resource:

Community Contacts List

Early Head Start Recruitment Flyer - Fillable

Early Head Start Recruitment Flyer - Printable

Early Head Start Home-Based Recruitment Flyer - Fillable

Early Head Start Home-Based Recruitment Flyer - Printable

ECEAP Recruitment Flyer - Fillable

ECEAP Recruitment Flyer - Printable

Head Start Recruitment Flyer - Fillable

Head Start Recruitment Flyer - Printable

Shared Waitlist Sites Recruitment Flyer - Fillable

Shared Waitlist Sites Recruitment Flyer - Printable

 

Eligibility

Eligibility Verification Form

Resources:

12-Month Income Verification Chart

Income Worksheet

Statement of No Income

 

Selection

Annual Selection Plan - fillable

 

Enrollment

Health/Nutrition:

Emergency Treatement and Consent Form

Health History (1-5 Years)

Health History (0-12 months)

Pregnancy Health History

Food Introduction Record

Authorization to Release and Exchange Confidential Health Information

As Needed:

Child Supplemental Food Plan

Parent/Guardian Request for Milk Substitute

Child Health Plan and Provider Orders — Non-Food Allergies

Child Health Plan and Provider Orders — Dietary Accommodations - Food Allergies/Intolerances

Child Health Plan and Provider Orders — Respiratory Disorder

Child Health Plan and Provider Orders — Seizure Disorder

Child Health Plan and Provider Orders — Skin Condition

Child Health Plan and Provider Orders — Reflux Infants and Toddlers

Child Health Plan and Provider Orders — Other Health Conditions

Declining Early Learning Health Services

Resources:

Health History Tool (1-5 Years)

Health History Tool (0-12 months)

Health/Nutrition Enrollment Flowchart

Dietary Accommodations and Food Preferences Flowchart

Immunization Requirements Procedure

Lead Letter to Providers

Diabetes Management in the Classroom

Medical/Dental Exam Letter

Family Engagment:

Family Connections

Family Connections - EHS Home-Based

As Needed:

Consent for Use of Interpreter

Family Strengths and Goal Planning Form

Resources:

Race and Ethnicity List

Family Engagement Opportunities

Family Engagement Guidance

Transitions:

Transition Action Plan

 

Attendance

Continuity of Care:

Continuity of Care Request for Funds

 

Documentation

Documentation Protocols

Family Contact Log:  PDF (print)   Word (fillable)

Family Engagement Notebook Procedure

Parent Training Topics Tracking Form