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Child File Forms


updated 2/26/20

ERSEA Information

What is Income?

2019-2020 Child File Checklist

2020-2021 HS Income Guidelines

Application Checklist/Selection Criteria

Group Selection form – or CP report 2025

Application Cover Sheet – ENGLISH / SPANISH

Head Start Emergency Card (blue card)

Child/Family Notes from Enrollment

Section 1

Enrollment Table of Contents

Inspection of Confidential Records

Change of Status *

Child Plus Application forms ENGLISH pg 1 pg 2

SPANISH pg 1 pg 2

Head Start Eligibility Verification

Applicant Eligibility & Enrollment Info. / Individual Systematic Selection Form

Income Source documentation: one or more of the following:

Homeless Verification form

No Income Verification form

   Tax Return, Check Stubs, W-2, etc.

Notification letter *

Acknowledgement of Parent Handbook signature form-ENGLISHSPANISH

Copy of birth certificate

Copy of Social --Security card

Copy of photo ID

Proof of Residency

Legal Documents*

Optional/Other Forms (district forms)*


Section 2

Health Table of Contents

Consent for Head Start Services ENGLISH – SPANISH

Health Coverage Form / Copy of Insurance

Child Health History ENGLISH – SPANISH

Child Nutrition Assessment ENGLISH  SPANISH

Release of Information-Dental ENGLISH – SPANISH

Dental Examination form

Release of Information-Physical ENGLISH – SPANISH

Physical Examination form

Head Start / WIC Permission for Release and Exchange of Information ENGLISH – SPANISH

Hemoglobin/Hematocrit  results

Lead results   State Lab Request form

Hearing and Vision Results -or- screener ENGLISH – SPANISH

Immunization record

Risk Assessment for Lead Exposure: Parent Questionnaire

Tuberculosis – Parent Questionnaire ENGLISH – SPANISH

BMI Letter w/Growth Charts*

In House Referral *

Accident Report *

Optional/Other Forms*

Denial of Service form


Section 3

Social Services Table of Contents

Progress Notes

Center-based Family Partnership Agreement ENGLISH – SPANISH

FPA Goals and Outcomes Assessment

Head Start Family Goals

In House Referral * 

Permission for Release and Exchange of Information * ENGLISH – SPANISH

Optional/Other Forms*


Section 4

Parent Involvement Table of Contents

Parent Education and Interest Questionnaire ENGLISH – SPANISH

Parent Communication Log

Child Tardy Log / Child Attendance Log

Attendance Documentation/Referral

Notes from parent/guardian *

Tardy/Absent Acknowledgement *

Tardy/Absent Notification Letter *

Need for Transportation/Enrollment*

Optional/Other Forms*

Social Media Release Form*

Section 5

Education Table of Contents


DIAL 4 Parent Questionnaire

DECA Report

Head Start Work Sample 

Anecdotal Notes –completed in Child Plus

CLI Progress Monitoring Reports –Wave 1,2,and 3

Home Visit/ Parent Conference form –filed at the end of the year

Transition Plan 

Field Trip Permission forms

In House Referral * 

Optional/Other Forms*



Section 6

Mental Health Table of Contents

Parental Consent for Mental Health/Behavioral Services ENGLISH – SPANISH

Progress Notes *

In House Referral * 

Individual Mental Health Observation Form*

Individual Positive Guidance Plan/follow up *

Permission for Release and Exchange of Information * ENGLISH – SPANISH

Optional/Other Forms*


Section 7

Special Education Table of Contents

In House Referral * 

IFSP/IEP/Secion 504 Plans or Disclaimer*

Parent Permission *

SST documentation *

Optional/Other Forms*