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Head Start Forms Online

Head Start forms descriptions for these forms. (September 2008)

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Administration

Fiscal Management

Approval for Meals and Refreshments

Child Care Advance OHSA

Long Distance Log

Material Supply Request Form

Material Supply Request Short Form

Parent Club Reimbursement Deposit

Parent Travel Cash Advance

Personal Travel Statement

Petty Cash Verification

Property Receipt

Purchase Order for Health Services (Follow-up)

Purchase Order for Health Services (Initial Exam)

Receipt Parent Travel & Childcare

Reimbursement Request: Non-Travel

Travel Authorization

Travel Reimbursement Request

Communication

Fax Coversheet

Information Routing Slip

Letterhead

Management Team Meeting Minutes

Weekly Center Staff Meeting Minutes

Human Resource Management

Accident Report - Employee

Accident Report - Employee No Medical Treatment

Accident Report - Volunteer

Applicant File Form

Application for Employment

Bloodborne Pathogen Incident – Accident Report

Bloodborne Pathogen Training and Hep B Vaccination Employee Change of Address and Emergency Contact

Employee Initial Physical Exam Letter

Leave Request Form

Orientation Checklist Adjunct Employee

Orientation Checklist New Employee

Performance Evaluation 90 Day

Performance Evaluation 120 Day

Performance Evaluation Assistant Teacher/Classroom Aide

Performance Evaluation Management Staff

Performance Evaluation Nutrition Aide

Performance Evaluation Nutrition Assistant

Performance Evaluation Teacher/Home Visitor

Plan of Assistance

Resource Timesheet

Staff and Volunteer Health Self-Appraisal

Staff Time Report Standards of Conduct

Training and Development

Education Funding Agreement

Individual Staff Training Record Mentor -Teacher Observation Note Staff Training Record Training Attendance Record Training Request Form

Quality Assurance

Governance

Community Grievance

Director’s Report to Grantee Board

Supervision and Monitoring

CACFP Site Monitoring Log CACFP Site Monitoring Report

Center Contact Record

Child File Checklist

Classroom Health, Nutrition and Safety Inspection

Classroom Observation

Comprehensive Staffing Form

Follow-up on File Review

Self-Assessment Checklist

Teacher Observation Weekly Work Schedule

Reporting

CACFP Monthly Report to Nutrition Manager

Classroom Monthly Attendance

Classroom Verification of Attendance

End-of-Year Checklist to Director

Home Visit Tracking to SD Supervisor & E&D Manager

Manager’s Monthly Report to Director

Monthly First Aid Supplies Report to Fiscal Manager

Monthly Report to Disabilites/Mental Health Manager

Monthly Report to Family & Community Partnership Manager

Monthly Report to Fiscal Manager

Monthly Report to Health & Nutrition Manager

Monthly Report to Education Supervisor

Monthly Safety Report to Education Supervisor

Student Accident Report

Weekly Center Cleaning Report to Health and Nutrition Manager Weekly Classroom Cleaning Report to Education Supervisor

Facilities Management and Maintenance

Link Text

ERSEA / Student Records

Authorization for Release of Information Authorization to Act as Parent Checklist of Enrollment Forms and Materials CACFP Baker CACFP Baker Spanish CACFP Elgin CACFP Elgin Spanish CACFP La Grande CACFP La Grande Spanish CACFP Union CACFP Union Spanish CACFP CIS Instructions CACFP Confidential Income Statement CACFP Confidential Income Statement Spanish CACFP Letter to Parents CACFP Letter to Parents Spanish Confidential Reporting Form Directions for Transfer of Records Head Start Application Head Start Application Spanish Head Start Enrollment Demographics Notice of Child In Protective Custody Parent Permission Slip Walking Field Trips Permanent Student Record Protected Child Agreement Student Withdrawal Form

Child Health and Development

Education

Activity Format Sheet

Additional Home Visit

Anecdotal Record Anecdotal Record Code Descriptions Assessment for Second Language Learners

Child and Family Cultural Profile

Child File Table of Contents

Child Release and Emergency Contact

Classroom Outcomes Plan Food Blood Glucose Diary Kindergarten Transition Plan Tracking Returning Student Transition Plan Tracking

Weekly Lesson Plan Checklist

Weekly Lesson Plan Format

Disabilities

Early Intervention Referral/Screening Form IFSP Checklist Service Provider Log Screening Results-Hearing Screening Results-Vision

Mental Health

Behavioral Data Collection Child Behavior Plan Individual Child Observation Staffing Notes Mental Health Classroom Observation Mental Health Provider Log Instructions Mental Health Referral Consent Mental Health Service Provider Log

Parent Permission for Play Group Participation

Play Group Tracking Staff Observation - Evaluation Recommendations

Health

Asthma Action Plan Asthma Action Plan Spanish Authorization For Release of Information Child Health Care Provider Information Child Health History Child Oral Health Assessment Child Physical Exam

Classroom Summary Allergies and Medications

Consent for Well Child Screening

Food and Blood Glucose Diary Lead Test Refusal Form Lice Exposure Letter Medication Administration/Parent Update

Medication Authorization Medication Log Notice of Exposure Seizure Health Care Plan

Nutrition

CACFP Enrollment Form English

CACFP Enrollment Form Spanish

CACFP CIS Instructions

CACFP Recipe – Combination Foods

CACFP Recipe Crediting Worksheet

Health In Action Nutrition and Activity Assessment Health In Action Nutrition and Activity Assessment Spanish

Medical Statement for Food Substitutions

Monthly Report for Meals Served AM

Monthly Report for Meals Served PM

Posted Food Restrictions

Questionnaire - Anemia

Questionnaire - Lead English

Questionnaire - Lead Spanish Release for Sharing Nutritional Information (WIC)Special Diet Daily Substitutions AM Special Diet Daily Substitutions PM WIC Participant Summary Request

Family and Community Partnerships

Family Services

Application for Temporary Transportation Subsidy

Family Crest

High School Equivalency Assistance Request

Partnership Agreement - Part II

Parent Center Committee

Fundraising Approval Form

Parent Attendance Log

Parent Center Committee Agenda Format

Parent Center Committee Report to Policy Council

Parent Training Plan

Volunteers

EOU Conditions of Volunteer Service Non-Federal Resource Voucher Parent and Volunteer Orientation Practicum Student Checklist Practicum Student Cover Sheet Summary - Miscellaneous In-Kind

Summary of Parent Volunteer Hours Volunteer Cover Sheet Volunteer Orientation Checklist

Volunteer Sign-in Sheet - Miscellaneous Volunteers

Volunteer Sign-in Sheet - Parent Classroom

Volunteer Survey

ontact Information

Eastern Oregon Head Start

One University Boulevard

Ackerman Hall Room 016

La Grande, OR 97850

Phone: 541-962-3506

E-Mail: jgoodric@eou.edu

Contacts at Head Start

Eastern Oregon University is a member of the Oregon University System

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