Memorandums
Resources
2023-24 Staff Calendar / Burlington, Mt. Pleasant, Ft. Madison, Keokuk IA – updated 12.7.23
2023-24 Family Calendar / Burlington, Mt. Pleasant, Ft. Madison, Keokuk IA -updated 12.7.23
Head Start Forms
Education
Facilities and Transportation Forms
Family Development Specialist Forms
Health Forms
Mental Health Forms
Nutrition Forms
Early Head Start Forms
Head Start Forms:
Administration Forms
- Child Care Reimbursement Form
- College Credit Request Form
- DHS Roster Sheet
- Emergency Procedures Guide sign-off
- Hepatitis B Immunization Consent or Refusal
- Incident Report
- Individualized Training Follow-Up & Evaluation
- Individualized Training Request
- In-Kind Material Report
- In-Kind Material Report fillable
- In-Kind Professional Sign-in Sheet (fillable)
- In-Kind Volunteer Sign-in Sheet (fillable)
- Iowa DHS Child Abuse Form
- No Cell Phone Zone Signs (B)
- No Cell Phone Zone Signs (C)
- Purchase Requisition (Excel sheet that will download)
- Staff Physical
- Substitute Evaluation
- Substitute Statement
- Supply Order Form
- Technology Repair Work Order 9.2019
- Time Off Request
- Time Sheet for Substitutes (fillable)
- Volunteer Statement
- Winter Weather Practices for Burlington
- Winter Weather Practices for Lee Co Henry Co
Education
Classroom
- ASQ: SE-2 Ages & Stages Questionnaires English Spanish
- Anecdotal Observation Tally Sheet 2-21
- Classroom File Checklist 8-21
- Classroom Postings Checklist 7-21
- Cleaning and Sanitizing Checklist 7-19
- English Language Learners Checkoff List
- Field Trip Request
- First PT Conf. Checklist 7-21
- Hands-On Nutrition Activity form
- Lending Library Permission Form
- Lesson Plan Guidelines 8-21
- Lesson Plan Fillable 7-21
- No-Go List 2019 fillable with cover
- Parent Observation Form
- Quarterly Goals Ed 1 fillable 7-21
- Quarterly Goals Ed 2 fillable 7-21
- School Readiness Goals 5-17
- Second PT Conf. Checklist 7-21
- Staffing Patterns
Class DOJO
Evaluation
- Employee Preparation for Performance Evaluation Form – Self Evaluation
- Job Shadowing by Substitutes
- Teacher 30-60 Day Review
- Teacher Associate Evaluation
Home Visits
- Family Literacy Questionnaire
- First HV-Summary Checklist 7-21
- Second Home Visit Transition Home Visit Checklist 7-21
Transition
- Kindergarten Release of Information
- Kindergarten Transition Timeline
- Sp La Accion de la Comunidad de la Liberacion del Sudeste de la Transicion del Jardin de la Infancia de Ventaja
- Transition Activities EHS into HS Classroom
- Transition checklist HS to Kindergarten
- Transition Checklist – Parental
- Transition Checklist EHS Enrolled in HS
- Transition Checklist HS to HS
- Transition Checklist New Enrollee in HS
- Transition Preparation Checklist EHS Enrolled in HS
Facilities and Transportation Forms
- Bus Monitor Competency Check List
- Bus Ride Report
- Bus Roster Sheet 2020-21
- Bus Safety Drill Checklist
- Classroom & Safety Monitor Monthly Checklist
- Cleaning Check List for Bathrooms 1.13.23
- Daily Playground Checklist
- Iowa Pre-Trip Bus Inspection Report
- Maintenance Request
- Monthly Inspection Carbon Monoxide Detector, Fire Extinguisher 11/15/23
- Monthly Playground Inspection Form
- Playground Safety Quarterly Checklist
- Transportation Letter to Parents Spanish
- Transportation Letter to Parents
- Wilson Chemical Order form
- Wilson Paper Supply Order Form
Family Development Specialist Forms
- 2022-2023 Application – Full
- AEA Release of Information
- Attendance Contract 2021
- Attendance Issue Form
- Checklist for Family Files (2022)
- Client Records Request Form 2021
- End of the Year Celebration Request Form
- Enrollment Agreement
- Expectant Mother Emergency Contact Form
- Extended Leave Request Form
- Family Event Sign-In Sheet (fillable)
- Family Handbook 2023-2024
- Family Partnership Agreement
- Family Specialist EHS to HS Transition Checklist
- Family Statement Form – no parent
- Family Strengths & Needs Assessment
- FDS First Home Visit Checklist 2022
- FDS Monthly Report
- Living Situation Verification
- Media Consent
- PACT Instructions 2022
- PACT Request Form
- Parent Group Center Committee Report
- Parent Permission Consent 2022
- Parent Request for Youth Pick-Up
- Referral Tracking Checklist
- Ready Rosie Registration Invite
- Release of Information (Family & Friends)
- Selection Criteria 2022-23
- Site Meeting Agenda 2023-24
- Site Yearlong Planning 2022
- Statement of No Income
- Termination Form (2021)
- Weekly Team Meeting
- Work Verification 2021
- 2022-2023 Health Packet – Full
- Certificate of Immunization
- Child Evacuation Assistance Posting
- Child Health History 2020
- Child Physical Exam Form 2023
- Daily Health Check
- Dental Form
- Edinburgh Postnatal test
- Emergency Alert (RED PAPER ONLY)
- Emergency Medical Release 2022
- Exposure Notices
- First Aid Checklist
- Food-Allergy-Anaphylaxis-Care-Plan-FARE_FILLABLE 5-2020
- Health Letter 2022- Physical, Dental, Immunization
- Hearing Screening Form
- Hirschberg Test
- Iowa Kidsight Consent Form
- Lead Risk Questionnaire 2020
- Lift the Lip Oral Screening Form
- Medication Log
- Medication Permission Form
- Monthly Drill Report
- No-Go List fillable
- Non-Food-Anaphylaxis-Allergy-2-sided
- Provisional Certificate
- Refusal of Services
- Release of Information for Outside Agency
- Screening Consent Form 2022
- Seizure-action-plan_fillable 4-2020
- Snellen Vision Form
- Sunscreen Log fillable
- Sunscreen Log
- Support Meeting Form update 2023 JH (Final)
- Support Meeting Guidelines 2023-2023 – JH (Final)
- Support Meeting Procedures – JH (Final)
- University of Iowa Release
Disability Tracking
- 0-5 month infant menu
- 6-11 month infant menu
- CACFP Enrollment Form Spanish
- CACFP Nutrition Form
- 2022-2023 CACFP Parent Letter
- Diet Modification Request Form
- Emergency Foods Menu
- Food Production Record-short form
- Infant Meal Pattern Chart
- Nutrition Assessment
- Nutrition Supply Order Form
- Temperature Log- Freezer
- Temperature Log- Refrigerator
Week A Menus
- Family Menu/ Cook FPR
- HS Menu
- EHS Menu
Week B Menus
- Family Menu/ Cook FPR
- HS Menu
- EHS Menu
Week C Menus
Week D Menus
- Family Menu/ Cook FPR
- HS Menu
- EHS Menu
Week E Menus
- Family Menu/ Cook FPR
- HS Menu
- EHS Menu
Week F Menus
- Family Menu/ Cook FPR
- HS Menu
- EHS Menu
Early Head Start Forms
- Attendance Chart
- Classroom Child File Checklist 9-19
- Classroom File Checklist 8.21
- Classroom Materials Assessment
- Classroom Mom File Checklist
- Classroom Posting List 7-21
- Daily Report
- Diaper Ointment Log
- Employee Performance Evaluation EHS Teacher 2020
- First PT Conf. Checklist 9-19
- Infant Foods Tried at Home
- Infant Sleep Position Exception
- Lesson Plan Template 8-21
- Restrictive Equipment Log
- School Readiness Goals 5-17
- Second PT Conf . Checklist 7-21
- Staffing Pattern-3 classes 8-14
- Staffing Pattern-5 classes 8-16
- Weekly Parent Schedule
- Well Child Visits