Applications
NEW FILLABLE APPLICATION! 2.1.2021
Online Pre-Application
Staff responsible for taking applications will regularly check the pre-application sheet in Google Sheets to check for families interested in the program they work with. Staff will try to connect with families 3 times by phone call and text. If there is no response, staff will mail the Pre-App Follow Up Letter for Families and send out an email to try to make contact. If there is still no response from the family after these attempts, staff will move the family information to the "No Response Pre-App CC and EHS Center Based" tab.
Refer to the Maintaining Online Pre-App Guidance for more information.
Refer to the Maintaining Online Pre-App Guidance for more information.
Before and After Lists for Parents
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Eligibility Verification Page
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Intake Forms
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Adobe Form Save-Save As Procedure 1/21
Docusign Procedure 1/21 Instructions for Completing the Client Intake HS/EHS Application Pg.1 & 2 |
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Family Income
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Families In TransitionAttach a copy of the Disclosure With Parental Consent form to the Families in Transition Questionnaire when submitting to the McKinney Vento Liaison.
Families in Transition Questionnaire McKinney Vento Liaison List 19/20 |
Health and Dental Forms and Releases
Medical/Dental Homes Guidance
While it is important to collect a fair amount of information and forms at time of application to identify eligibility, it is also important to begin the process of identifying needs with families. One piece in identifying needs is to consult with parents to determine whether each child has ongoing sources of continuous, accessible health care – provided by a health care professional that maintains the child’s ongoing health record and is not primarily a source of emergency or urgent care (HSPPS 1302.42). This includes both medical and dental homes.
Please see the following for how to enter this information accurately on the application and for CP entry.
While it is important to collect a fair amount of information and forms at time of application to identify eligibility, it is also important to begin the process of identifying needs with families. One piece in identifying needs is to consult with parents to determine whether each child has ongoing sources of continuous, accessible health care – provided by a health care professional that maintains the child’s ongoing health record and is not primarily a source of emergency or urgent care (HSPPS 1302.42). This includes both medical and dental homes.
Please see the following for how to enter this information accurately on the application and for CP entry.
- Dental and medical homes are only written on the application if the child has been seen by the dental or health clinic.
- If the dental and/or medical home is listed on the application, DMT will mark “yes” at enrollment for this child.
- If there is not a medical or dental home listed on the application “no” will remain on CP (PIR) “At Enrollment”.
- When an FSS or CCSC receive a WBC or dental form for a child that did not have a medical home/dental home on their application, they must change CP (PIR) to Yes (At End Of Enrollment) because they found a medical/dental home while working in our program.
Health Forms and Releases
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EHS Child Health History
HS Child Health History |
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EHS Child Development and Care Subsidy
Recertification
A recertification is used when a child was enrolled for the 2020-2021 school year as an income eligible child and the family intends for the child return to the same program. The Guidance for completing Head Start Recertification and Health Release Over the Phone (4/2020) explains the recertification process.
Recertification 2021
A recertification is used when a child was enrolled for the 2020-2021 school year as an income eligible child and the family intends for the child return to the same program. The Guidance for completing Head Start Recertification and Health Release Over the Phone (4/2020) explains the recertification process.
Recertification 2021
| Recertification 2020 |
Recruitment Materials
GSRP Applications ONLY
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