CHILD & FAMILY DEVELOPMENT PROGRAMS

Forms Tracker 2008 - 2009

Last Updated: February 5, 2010

 

CP1 Enrollment/Drop Form
CP 2a Child Health & Dev. Tracking - 45 days
CP 2b Child Health & Dev. Tracking - 90 days
CP 3 Change of Status
CP 4 Child Supplemental Family Member Information  
CP 5 Family Service Transaction Form
CP 6 Training Evaluation Log
CP 7 PIR Addendum Questions
CP 8 Disability Worksheet
CP 11 Mental Health
CP 13 Eligibility Priority Criteria
   
   
   

Policy 1-1    

Staff Health

Policy 1-2

Policy Council Gas Stipend

1-3

Site Visit Report

1-4

Property Log and Inventory

1-5

Professional & Personal Dev. Plan

1-6

Communication Checklist

1-7

Child Abuse & Neglect Report

Policy 1-8 

Training Sharing Policy

Policy 1-8 sp

Training Sharing Policy in Spanish

Policy 1-9 

Health and Safety Policy

1-10

Bus Mileage

Policy 1-11

Inclement Weather

Policy 1-11 sp

Inclement Weather in Spanish

Policy 1-12

Child Abuse and Neglect

Policy 1-12 sp

Child Abuse and Neglect in Spanish

Policy 1-13

Recruitment Policy and Criteria

Policy 1-13sp Recruitment Policy & Criteria in Spanish

Policy 1-14 

Attendance

Policy 1-14 sp Attendance in Spanish

1-15

Intern Evaluation

1-16

Vernonia Facility Use Form

1-17

Employee Evaluation Conference

1-18

Time log for hours away from worksite

Policy 1-19

Child Education Record Policy

Policy 1-20

Client Confidentiality (Program)

Policy 1-20a

Client Confidentiality (Volunteer)

Policy 1-20a sp

Spanish version of Client Confident.

1-21

Long Distance Calls

Policy 1-22

Parent Reimb. Child Care/Travel

Policy 1-23

Transportation Policy for Staff

1-24

Financial Assistance Form

1-25

Personnel Information Sheet

1-26  

Staff Medical Statement of Health

Policy 1-27

Professional Certification related to Salary Scale

Policy 1-28

Certification & Licenses

Policy 1-29  

Training Advance Professional

1-29a

College Planning Sheet

1-30

Petty Cash Reconciliation

1-31

College Expense Special Request

1-32

Staff Conference Forms

Proc. 1-33

USDA Discrimination Complaint

1-33a

Civil Rights Training Questions

Proc. 1-34

Hiring Procedure

1-35

Disbursement Voucher

1-36

Bus Monitor Training Record

1-37 CAT Incident Report/Investigation

Policy 1-38

CAT Board & Policy Council Respons.

Proc. 1-39

Computer Procedure

Policy 1-40

Key Policy

Proc. 1-41

Form Revision Procedure

1-42

Payroll Advance (Draw) Request

Policy 1-43

Parent-Employee Guidance

Proc. 1-44

Child Files at end of the year

1-45

Training Evaluation

Proc. 1-46

Restraints on Buses

Policy 1-47   

Transportation Policy for Participants

1-47a                  CCD

Trans. Pick Up/Drop Off Information

1-48

Grant Summary

1-49

Training & Technical Assistance

Policy 1-50 

Staff Children Policy

1-51

Employee Action Checklist

1-52

Employee Action Notice

1-53

Plan for Improvement

Proc. 1-54

Child Arrival & Departure

Form 1-54a        CCD Classroom Daily Check In/Out Log

1-55

Recommendation for Employment

1-56*

Purchase Order for Cook

Proc. 1-57

Contract Development Procedure

1-58

Reference Checklist

1-59

Driver’s Daily Pre-Trip Checklist

Proc. 1-60

Monitoring Outcomes Data

1-61

Evaluation Questionnaire

1-62

CAT PL Cash Out Form

1-63

Employee Application

1-64

Time Sheet

1-65

Mileage Sheet

Proc. 1-67 Maintaining Child Plus Data Entry
1-68 Area supervisor's File Review Checklist

Policy 1-69

Hiring Substitute Center person

Policy 1-69sp

Spanish version of 1-69

Form 1-70 Performance Appraisal Review 3,6,9 Months

1-71

Volunteer Declaration

1-71 sp

Spanish Volunteer Declaration form

Proc. 1-73

Addressing Program Concerns

1-74   

First Aide Kit Checklist

Proc. 1-75 In-House Student Transfer
Proc. 1-76 Insect & Pest Control
Proc. 1-77 Verifying Applicant Qualifications

Policy 1-78

Payment for Meals

Policy 1-78sp

Spanish Payment for Meals

Policy 1-79

Child Care Payment Policy

Proc. 1-80 Days of Service and Class Days

1-81

Sign-In Sheet for Child’s File

Policy 1-82     

Parent/Community Grievance

Policy 1-82 sp.

Spanish version of Parent Grievance

1-83

Confidentiality of Computer and Network Resources Assurance Statement

Proc. 1-84 Accessing CFDP CDA Advisor
1-85 Computer Password Tracker

1-86

Per Diem Request

1-87

Travel Reimbursement

Policy 1-88 

Siblings in the Classroom

Policy 1-89 Tobacco Free Environment

1-90

Voluntary P.L. Transfer Request

1-91

Income Documentation

Policy 1-92

Family Partnership Policy

Policy 1-93

Dispute Resolution

 

 

2-1 (c)

Lesson Plan – Planning Monthly Requirements

 

2-1 (d)

Lesson Plan form D – Ind. Goals

 

2-2

Child Learning Profile–Interest & Goals

 

2-3 CCDC Questions 51 & 52

2-4

About my Family

 

2-4 sp

About my Family

 

2-5

Field Trip Plan Authorization

 

2-5a                    CCD

Field Trip Report

 

2-6*

Home Visit

 

2-6* sp

Spanish version of Home Visit

 

2-7*  

Individual Child Planning

 

2-7* sp

Spanish version of Individual Planning

 

Proc. 2-8 DECA Documentation and Planning Procedure
Proc. 2-9 Monitoring & Data Entry Guide Procedure for CCDC and CCNet

Policy 2-10

Field Trip

2-11

Specific Field Trip Permission Slip

 

2-11sp

Specific Field Trip Permission (Span)

 

2-12*

Home Visit Agreement Letter

 

2-12* sp

Spanish Home Visit Agreement Letter

 

2-13a

Health/ Safety Checklist (teachers)

 

2-13b

Health/Safety Checklist (CM)

 

2-13c

Health/Safety Checklist (cooks)

 

Policy 2-14 

Home Visit Policy

Policy 2-14 sp

Spanish Home Visit Policy

Procedure 2-15 Ongoing Monitoring Procedures

Procedure 2-16 

Classroom Observation

 

Proc. 2-17

Parent Teacher Conference

 

Guidance 2-17a

Parent Teacher Conference Guidance

 

2-18*

Talk about Touching Letter

 

2-18* sp

Spanish Talk about Touching Letter

 

2-19

Home Visit Pamphlet

 

2-19 sp Spanish Home Visit Pamphlet

2-20

Notice of Family Contact

 

2-21

Home Visit Evaluation

 

2-21a

Home Visit Summary

 

Policy 2-22          CCD

Animals in the Classroom

 

Proc. 2-23

Bus Evacuation Procedure

 

2-24

Fire Drill Observation/Evaluation

 

2-24a

Earthquake Drill

 

2-24b

Bus Evacuation Drill

 

2-25

Home Visit Observation Checklist

 

2-26

ECERS Technical Assistance Plan

 

Policy 2-27

Child Discipline (Staff)

 

Policy 2-27a

Child Discipline (Parents)

 

Policy 2-27a (sp)

Parents Spanish form

 

2-28

General Walking Trip Permission Slip

 

2-28 sp

Spanish General Walking Permission Slip

 

Proc. 2-29 Data Entry Guide for CCDC Class Summary Worksheet

2-30

Authorization to Act as Parent

 

2-30 sp

Spanish Auth. To Act as Parent

 

Proc. 2-35

School Bus Trans. Safety Ed for Parents

 

Proc. 2-35 sp School Bus. Trans. Safety Ed - Spanish

 

3-1*

Ouch Form

3-1* sp

Spanish Ouch Form

Proc. 3-2  

Expectations of HSAC

3-3

Lead Checklist

3-3sp

Spanish Lead Checklist

3-4

Emergency Health Problems Tracking

Proc. 3-5

Referrals Procedure

3-6

Nutrition Survey

3-6 sp

Nutrition Survey in Spanish

3-7

Consent to Exchange Information

3-7 sp

Spanish Version of 3-7

Policy 3-8 

Administering Medicines to Student

Policy 3-8sp

Spanish Version of 3-8

3-8a

Medication Permit and Log

3-8a sp

Medication Permit in Spanish

Policy 3-9   

Health Services Policy

Policy 3-9sp 

Spanish Health Services Policy

Policy 3-10 Parent Request for Food Substitution
Policy 3-10 sp Request for Food Substitution in Spanish

3-11

Emergency Notification Card

3-11sp

Spanish Emergency Notification

3-12

Medical Statement for Food Subst.

Proc. 3-13

Medication Labeling & Storage

Policy 3-14   

Management Guide for Responding to an Occupational Exposure Incident

Policy 3-15a

Dealing w/Students having AIDS, HIV, ARC or Hepatitis

Policy 3-15b

HIV, AIDS (Students)

Policy 3-15c

HIV+, AIDS (Staff)

Policy 3-15d

HIV+, AIDS Rumor Control

Policy 3-15e

Staff Accommodations (HIV, AIDS)

Policy 3-15f 

Infection Control

Policy 3-15f sp Infection Control - Spanish

Policy 3-15g

HIV+ or AIDS (Press/media)

3-16

Examination Reminder (letter)

Proc. 3-17

Screening Results Guide

Policy 3-18 

Head Lice/Nits Policy

Policy 3-18 sp

Head Lice/Nits Policy in Spanish

3-18a

Treatment of Headlice

3-18a sp

Treatment of Headlice Spanish ver.

Policy 3-19  

Exclusion of Children from Attend.

Policy 3-19 sp

Spanish Exclusion of Child. From Attn.

3-19a

Exclusion

3-19a sp  

Spanish Exclusion

Proc. 3-20

Yearly Screening Guidance

3-21

Report of Accident to a Child

3-22

Dental Letter

3-23

Medical Home Letter

Proc. 3-24

Toothbrush Procedure

3-25        

Denial of Consent for Medical/Dental

3-25 sp   

Spanish Denial of Consent for Med.

Proc. 3-26

Handwashing Procedure

3-27

Children’s Log of Injuries & Accidents

Policy 3-28

Nutrition Policy

Proc. 3-28a       

Family Style Meal Service

3-29

Food Budget Control

Policy 3-30

Medical Home Policy

Proc. 3-31             

Toileting Procedure

Policy 3-32 

Emergency Medical/Dental Action

3-34 Child Food Recall

3-36

Nutrition Info. Summary to WIC

Policy 3-37

Fluoride Policy

Policy 3-37 sp Fluoride Policy in Spanish

3-38

HSAC Contract

3-40

USDA Recipe Form

3-41

Menu Production Record

Proc. 3-42

Assist parent to obtain Health & Dental Services

3-43

Health & Safety Log

3-44 Health History
3-44 sp Health History - Spanish

Proc. 3-45           CCD

Sanitation Linen, Bedding & Cots

3-46

Individual Care Plan

3-47

Health Screening Letter

3-47 sp Health Screening Letter in Spanish

3-48

Asthma Information

3-49* Cook's Point of Service Meal Count

  

4-1

Parent Committee Center Training Plan

4-2

Child Care Payment Request

Proc.  4-3

In-Kind Processing

4-3a

Policy Council Committee Meeting

4-3b

Space Evaluation for In-Kind

4-3c   

In-Kind

4-3e

In-Kind Donations and Services

4-4

Policy Council Credential

4-5

Working Relationship/SCF

Policy 4-6

Parent Activity Fund

4-7

Family Interest Survey

4-7 sp

Spanish Family Interest Survey

4-8

End of Year Survey

4-8 sp

End of Year Survey in Spanish

4-9

CTA Application

4-9 sp CTA Application in Spanish

4-9a

CTA Monthly Work Plan

4-9b

CTA Volunteer Placement

4-9c

Time Record for CTA program

4-9d

CTA Checklist

4-9e

CTA Final Evaluation

4-10

Family Visit Observation Form

Policy 4-11 

Volunteer Policy

4-12 Policy Council 2-Way Communication Form

 

5-1

Permission Slip for Children

5-1 sp

Spanish version of Permission Slip

5-2

Contact Sheet

5-3a

Family Interest Resource book list

5-4  

Family Partnership Agreement

5-4 sp

Spanish FPA

5-5

Media Permission Slip

5-5 sp Media Permission Slip in Spanish

5-6

Child Application

5-6 sp

Spanish Version of 5-6

5-6a Income Verification Worksheet

Proc. 5-7

Maintaining Working Relationship

5-8

Policy Council Minutes form

5-9

Drop Form

5-9sp

Spanish Version of 5-9

5-10

SOAP

5-10a

Signature Sheet for SOAP Files

5-10b

Table of Contents

5-11*

Staffing Record/Staff Meeting Minute

5-12

Self Declaration Form

5-12 sp

Spanish Version of 5-12

5-13

Referral for Mental Health Counsel.

Proc. 5-14

Child File Set-Up

5-16

Absentee Follow-up Report

5-17

Selection Letter

5-17 sp

Spanish Version of 5-17

5-18

Waiting List Letter

5-18 sp

Spanish Version of 5-18

5-19 Second Year Selection Letter
5-19 sp Spanish 2nd Year Selection Letter
5-20 Income Verification Letter - Child Support
5-20 sp Spanish Income Verification Letter - Child Support
5-20 a Income Verification Letter - Foster
5-20 a sp Spanish Income Verification Letter - Foster
5-21 TANF Income Verification Letter
5-21 sp Spanish TANF Income Verification Letter

Proc. 5-22

Court Policy

5-24

Transition Meeting Summary

Policy 5-26

Transition Policy

Proc. 5-26a

Transition Meeting Preparation

5-27

Parent Gas Stipend Agreement

5-27 sp

Spanish Parent Gas Stipend

5-65

Parent Gas Stipend

Policy 5-66

Parent/Gas Stipend Policy


 

6-1

Parent Notification of IEP Meeting

6-9

Parent Permission for Evaluation

6-10

Diagnostic or Interim IEP

  

8-1

Die Cut Request Form

8-2

Boardmaker Request Form

 

 

JOB DESCRIPTION

 

Area Supervisor

Assistant Teacher

Associate Director

Bilingual Assistant

Bilingual Assistant for Healthy Start

Building Manager     

Bus Driver

Bus Monitor

Center Manager        

Center Volunteer

Child Care Aide
Child Care Provider

Clerical Aide

Community Teacher Specialist

Cook

Court Parenting Specialist

Custodian

Director

Family Advocate

Family Worker
Floating Aide

Healthy Start Family Assessment & Support Worker

Healthy Start Program Manager
Nutrition Aide

Office Support

Office Support Specialist

Parent Involvement Assistant

Parent Support Coordinator

Parent Trainer

Parent Trainer Bilingual Assistant
Prep Cook

Teacher              

Traveling Teacher

Work Study Assistant

 
 

MISCELLANEOUS FORMS

CAT - Self Reliance Index
Blue Flyer
Blue Flyer - Spanish
CCDC Questions, Answers and Definitions
CFDP Letterhead
1 Year HS Child Participation - English
1 Year HS Child Participation - Spanish
2 Year HS Child Participation - English
2 Year HS Child Participation - Spanish
Parent/Guardian Participation - English
Parent/Guardian Participation - Spanish
Volunteer - English
Volunteer - Spanish
Menus
Curriculum Guide Supplement
Vision/Mission Statement
Integrated Work Plan
Income Guidelines for Head Start
Parent Handbook in English
Parent Handbook in Spanish

 

Healthy Start Manager Forms

2008 Budget Form
ASQ Tracking Table
3-4 Retention Analysis
3-4 Retention Measurement Worksheet
Quarterly Provider Cost
Core Training Log
Phone Refusal HS Follow-Up
Kempe Inter-Rater Reliability
Medicaid Carryover
Observation of Home Visit
Supervision Form
Family Supervision Form
Individual Program Support Plan
Observation of Family Assessment
QA Phone Survey
Screening and Acceptance Tracking
Staff Cultural Competency Survey
Program Report
In-Kind Declaration Form
Bi-Yearly Retention Worksheet
Supervision Notebook

 

FSW Forms

4-2B Home Visit Completion & Caseload Management
Consent to Contact Form English
Consent to Participate
Data Tracking Form
Dr. Letter
Dr. Letter Participant no Longer in Program
Family Rights & Confidentiality Policy
File Content
For My Child English-O
Form My Family
Home Visiting Policy
Family Transfer Summary
Home Visit Record
IFSP
NPC Form
Photo Release
Referral Tracking Form
Release of Information
Service Level Form 1
Service Level Form 1 SS
Service Level Form 2
Service Level Form 3
Service Level Form 4
Service Level Form P
Service Level Form X
Case Plan
Self Study Training Log
Time Study Form (Medicaid Log Sheet)
6 Month Training Log
12 Month Training Log
Ongoing Training Log
Prior to Working with Families Log
Training Topics Checklist
Kempe Lined
Monthly Service Log
Student Parent Progress Report Master
Student Parent Progress Report Sample
Professional Training

 

FSW Forms in Spanish

Family Rights and Confidentiality
What I Want for My Child
What I Want for My Family
IFSP
Release of Information