1. Application - Lower Columbia College Homepagelcc.ctc.edu/info/...Recruitment-Selection-Enrollment-Attendance.pdf(Revised 03/18) Lower Columbia College Head Start/EHS/ECEAP Eligibility,

(Revised 05/18)

Lower Columbia College Head Start/EHS/ECEAP

Eligibility, Recruitment, Selection, Enrollment, Attendance (ERSEA)

Table of Contents

1. Application

a. Head Start/Early Head Start/ECEAP Application (English & Spanish) (Revised 05/18)

b. Enrollment Postcard (English & Spanish) (Revised E: 08/10; S: 03/10)

c. No Income Statement (Revised 05/18)

d. Release of Confidential Information (English & Spanish) (Revised 05/17)

d1. Parent/Guardian Permission to Reveal or Obtain Confidential Information Procedure (Rev. 05/17)

e. Change of Status Form (Revised 07/14)

f. Adult Permission to Reveal or Obtain Confidential Information (Revised 11/13)

2. Attendance

a. Attendance and Meal Count Instructions (Revised 03/18)

b. Attendance and Meal Count Form (ChildPlus Report 2315)

b1. Daily Infant Meal Record (Revised 09/17)

c. Attendance Policy and Procedure (Revised 08/17)

d. (Vacant)

e. EHS Attendance Policy and Procedure (Revised 06/16)

e1. EHS Attendance Tracking Form (Revised 12/13)

e2. EHS Prenatal Attendance Tracking Form (Revised 12/13)

f. 3-5 Child Attendance Letter (English & Spanish) (Revised 07/10)

f1. EHS Home Base Child Attendance Letter (English & Spanish) (C: E-07/10; R: S-07/11)

f2. EHS Home Base Unable to Contact Letter (Revised 07/12)

g. (Vacant)

g1. EHS Home Base Attendance/Agreement Plan with Parent/Guardian (Revised 06/16)

3. Enrollment of Families

a. Selection of Families Policy and Procedure (English & Spanish) (Revised 02/16)

b. Statement of Eligibility (Revised 07/16)

b1. Verification of Homeless Status (Created 04/11)

c. EHS Enrollment of Families (English & Spanish) (Revised 02/16)

d. Head Start Selection Criteria Score Sheet (English & Spanish) (Revised 02/16)

d1. EHS Selection Criteria Score Sheet (English & Spanish) (Revised 02/16)

e. Enrollment of Families Policy and Procedure (English & Spanish) (Revised 07/17)

4. Intake of families

a. Intake Appointment & Forms Checklist (Revised 03/15)

a1. EHS Intake/Enrollment Visit (Revised 08/16)

a2. Prenatal Intake/Enrollment Visit (Revised 06/16)

5. Recruitment

a. Recruitment Policy and Procedure (Revised 02/12)

b. HS/EHS/ECEAP Rack Card (recruitment) (English & Spanish) (Revised 02/18)

c. Head Start/EHS/ECEAP Poster (Revised 02/18)

d. QRC Card (recruitment) (English & Spanish) (Created 02/18)

e. Logo Use Procedure & Guide (Created 02/18)

f. Logos (Created 02/18)

6. Community Assessment

a. Community Assessment Policy & Procedure (Revised 07/10)

ERSEA 1a

(C: 04/14; R: 05/18)

LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Physical Address: 1720 – 20th Avenue, Longview, WA 98632

Mailing Address: PO Box 3010, Longview, WA 98632 (360) 442-2800 FAX: (360) 442-2819

E-mail: [email protected] Website: http://lowercolumbia.edu/head-start/index.php

Eligibility Application Please fill in the form completely and accurately. All information will be kept confidential. It will be used to help us determine if your family is eligible for services and to prioritize your placement on the waiting list. If you have any questions about this application, or need any help in completing it, please call us. We will be glad to help!

For Pregnant Applicants: Pregnant Applicant Name: Due Date:

Are you working on your High School Diploma or GED? Yes No

For Child Applicants: Child’s Name: Date of Birth: (First, Middle, Last)

Sex: Male Female Language(s) Child Speaks: Address: Home: (Address) (City) (Zip)

Mailing (if different): (Address) (City) (Zip)

Are there any areas you would like support / resources for your child? Yes – check all that apply No Dental Health Physical Health Former Foster Child Nutrition/Eating

Vision Hearing Speech

Abuse/Neglect Behavior Learning Difficulties

Primary Parent/Guardian Information One or two parent household? One Two

Parent/Guardian’s Name: (First, Middle, Last)

Date of Birth: Relationship to Child: (Ex: Mother, Father, Foster Parent, Grandparent, Step Parent, etc.)

Telephone: (Cell) (Home) (Work) (Other)

E-mail address:

In what language do you prefer to communicate: English Spanish Other

Are you or your spouse/partner working on your High School Diploma or GED? Yes No

Secondary Parent/Guardian Information Lives in home with child? Yes No

Parent/Guardian’s Name: (First, Middle, Last)

Date of Birth: Relationship to Child: (Ex: Mother, Father, Foster Parent, Grandparent, Step Parent, etc.)

Telephone: (Cell) (Home) (Work) (Other)

E-mail address:

In what language do you prefer to communicate: English Spanish Other

mailto:[email protected]

http://lowercolumbia.edu/head-start/index.php

ERSEA 1a

(C: 04/14; R: 05/18)

Past participation in Head Start/EHS/ECEAP? No Yes If yes, Within past 3 years? Transferred from another Head Start/ECEAP?

Is this child on an IEP/IFSP (Special Education)? No Yes – Name of the school district/provider:

Special Agency Referral from:

Is this child’s family currently receiving Child Protective Services (CPS)? Yes No

Is this child’s family currently receiving Family Assessment Response (FAR) services? Yes No

Does this household receive subsidized housing, such as housing voucher or cash assistance for housing? Yes No

Do you have needs for yourself or other family members? Yes – check all that apply No Disability/Unable to Work Drug/Alcohol Issues Incarcerated Parent Family Violence

Learning Disabilities Mental Health/Illness Health Issues

Abuse/Neglect Domestic Violence Chronic Illness in Family

Family Size and Income Number of people in your household that your income supports:

Is your family homeless? Yes No

Is your family currently receiving TANF benefits? Yes Client ID # No Formerly

Is your family receiving Supplemental Security Income (SSI)? Yes No Family

Member Amount Per (for example: week,

month, year) Annual Amount Description (for example: SSI,

Job, Child Support)

$ $

$ $

$ $

Please bring proof of your family income for the last calendar year or the last 12 months with this application. Bring copies of all that apply: W-2 forms, income tax return, TANF benefits, unemployment summary, child support, social security, financial aid, SSI, pay stubs.

Emergency Contacts Primary Name: (First, Last) (Relationship to child)

Address: City: State: Zip:

Telephone: (Cell) (Home) (Work)

Secondary Name: (First, Last) (Relationship to child)

Address: City: State: Zip:

Telephone: (Cell) (Home) (Work)

Lower Columbia College Head Start/ECEAP does not discriminate against any person on the basis of race, color, national origin, disability, or age in admission, treatment, or participation in its programs, services and activities, or in employment.

I certify that this eligibility information is true. I understand that the information in this application will be held in confidence within the agency and is accessible to me during normal business hours.

Parent/Guardian Signature _______________________________________ Date __________________________

ERSEA 1a

(C: 04/14; R: 05/18)

LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP Dirección Física: 1720 – 20th Avenue, Longview, WA 98632

Dirección Postal: PO Box 3010, Longview, WA 98632 (360) 442-2800 FAX: (360) 442-2819

Correo Electrónico: [email protected] Sitio web: http://lowercolumbia.edu/head-start/index.php

Solicitud de Elegibilidad Por favor llene este formulario con la información completa y correcta. Toda la información se mantendrá confidencial. Esta información será usada para ayudarnos a determinar si su familia es elegible para los servicios y la prioridad de su solicitud en la lista de espera. Si usted tiene alguna pregunta acerca de esta solicitud o si necesita ayuda para completarla, por favor llámenos. ¡Estaremos encantados de ayudarle!

Para Mujeres Embarazadas: Nombre de la solicitante embarazada: Fecha de Parto:

¿Está tomando clases para sacar su diploma o GED? Sí No

Para Niños: Nombre del Niño: Fecha de Nacimiento: (Primero, Segundo, Apellidos)

Sexo: Masculino Femenino Idioma(s) que el niño sabe hablar:

Dirección: De casa: (Dirección) (Ciudad) (Código Postal)

Postal (si es diferente): (Dirección) (Ciudad) (Código Postal)

¿Quisiera ayuda o recursos para su niño en alguna área? Sí – Por favor marque todos que correspondan No

Salud Dental Salud Física Niño previamente colocado en

un hogar de padres temporales Nutrición/Comer

Vista Oído Habla

Maltrato/Negligencia Comportamiento Dificultades para Aprender

Información del Padre/Madre/Tutor ¿Están uno o dos padres en la casa? Uno Dos Nombre del Padre/Madre/Tutor: (Primero, Segundo, Apellidos)

Fecha de Nacimiento: Relación con el niño: (Ej.: Madre, Padre, Padre de Cuidado Temporal, Abuela, Padrastro, etc.)

Teléfono: (Celular) (Casa) (Trabajo) (Otro)

Dirección de Correo Electrónico:

¿En qué idioma prefiere la comunicación?: Inglés Español Otro ¿Está usted o su esposo/pareja tomando clases para sacar su diploma o GED? Yes No

Información del Padre/Madre/Tutor (en la misma casa) ¿Vive en la misma casa que el niño? Sí No Nombre del Padre/Madre/Tutor: (Primero, Segundo, Apellidos)

Fecha de Nacimiento: Relación con el niño: (Ej.: Madre, Padre, Padre de Cuidado Temporal, Abuela, Padrastro, etc.)

Teléfono: (Celular) (Casa) (Trabajo) (Otro)

Dirección de Correo Electrónico:

¿En qué idioma prefiere la comunicación?: Inglés Español Otro

ERSEA 1a

(C: 04/14; R: 05/18)

¿Ha participado Ud. anteriormente en el Head Start, EHS o ECEAP? No Sí Si es que sí, ¿Fue en los 3 años pasados? ¿Se está cambiando de otro programa del Head Start o ECEAP?

¿Tiene este niño un IEP o IFSP (Educación Especial)? No Sí – Nombre del Distrito Escolar o Proveedor:

Agencia Especial que lo remitió:

¿Está la familia de este niño actualmente recibiendo servicios de Servicios de Protección Infantil (CPS)? Sí No

¿Está la familia de este niño actualmente recibiendo servicios de Respuesta de Evaluación Familiar (FAR)? Sí No

¿Recibe esta familia subvenciones para la vivienda, como un bono o ayuda en efectivo para vivienda? Sí No

¿Tiene usted o un miembro de su familia alguna necesidad? Sí – Favor de marcar todos que correspondan No Discapacidad/No puede Trabajar Problemas de Drogas o Alcohol Padre o Madre Encarcelado Violencia Familiar

Problemas de Aprendizaje Salud/Enfermedad Mental Problemas de Salud

Maltrato/Negligencia Violencia Doméstica Enfermedades Crónicas

en La Familia

Ingreso y Número de Personas en la Familia Número de personas que viven en el hogar y dependen de sus ingresos:

¿Son ustedes una familia sin hogar? Sí No

¿Recibe su familia beneficios de TANF? Sí N° de cliente No Anteriormente

¿Recibe su familia beneficios de Seguridad de Ingreso Suplementario (SSI)? Sí No Miembro

de la Familia Cantidad Por(por ejemplo: semana,

mes, año) Cantidad Anual Descripción (por ejemplo:

Trabajo, Pensión Alimenticia, SSI)

$ $

$ $

$ $

Por favor, entregue con esta solicitud comprobantes de los ingresos de su familia durante el año pasado o de los últimos 12 meses. Entregue copias de todos que correspondan: formularios W-2, declaración de los impuestos sobre el ingreso, beneficios de TANF, reporte de desempleo, manutención de niños, seguridad social, ayuda financiera estudiantil, SSI, talones de pago.

Contactos de Emergencia

Primario Nombre: (Primero, Segundo, Apellidos) (Relación al niño)

Dirección: Ciudad: Estado: Código Postal:

Teléfono: (Celular) (Hogar) (Trabajo)

Secundario Nombre: (Primero, Segundo, Apellidos) (Relación al niño)

Dirección: Ciudad: Estado: Código Postal:

Teléfono: (Celular) (Casa) (Trabajo)

Lower Columbia College Head Start/ECEAP no discrimina a ninguna persona en base a su raza, color, nacionalidad, discapacidad o edad, para la admisión, tratamiento o participación en sus programas, servicios y actividades o en empleo.

Yo certifico que la información para elegibilidad es verdadera. Entiendo que la información en esta solicitud será usada confidencialmente por la agencia y que estará accesible para mí durante las horas normales de trabajo.

Firma del Padre/Madre/Tutor(a) _________________________________________ Fecha _____________________________

Thank you for your recent interest in Lower Columbia College Head Start/EHS/ECEAP.

Your application is complete; however our classes are full at this time. We will

contact you when an opening is available for your child.

In order to process your child’s application, we need you to bring in or mail

whichever documents show your total income for the last 12 months or

calendar year: Income Tax form 1040 and W-2’s for the previous year; Public

Assistance: TANF, SSI, WCCC; Unemployment history; Social Security, Child

Support, etc.

We have tried to contact you by phone with no success. Please contact us

at 442-2800 with a current phone number and address.

Telephone 442-2800

FAX 442-2819








Support, etc.



Telephone 442-2800

FAX 442-2819








Support, etc.



Telephone 442-2800

FAX 442-2819








Support, etc.



Telephone 442-2800

FAX 442-2819

Lower Columbia College

Head Start/EHS/ECEAP

1600 Maple Street

PO Box 3010

Longview, WA 98632



1600 Maple Street

PO Box 3010

Longview, WA 98632



1600 Maple Street

PO Box 3010

Longview, WA 98632



1600 Maple Street

PO Box 3010

Longview, WA 98632

Gracias por su reciente interés en el Programa del

Lower Columbia College Head Start/ECEAP.

Su solicitud está completa, sin embargo en estos momentos nuestras clases

están Completas. Nosotros lo contactaremos cuando haya una vacante

disponible para su niño.

En orden de procesar la solicitud de su niño, necesitamos que nos traiga o

envíe por Correo cualquiera de los documentos que comprueben sus ingre

sos totales por los últimos 12 meses o del calendario annual: Forma 1040 de

Income Tax y W-2 del año pasado, Asistencia Pública: TANF, SSI, WCCC;

Historial de Desempleo; Social Security, Pensión Alimenticia, etc.

Hemos tratado de contactarlo por teléfono sin éxito. Por favor llámenos al

442-2800 para darnos su número de teléfono y domicilio actuales,

Telephone 442-2800

FAX 442-2819













Telephone 442-2800

FAX 442-2819













Telephone 442-2800

FAX 442-2819













Telephone 442-2800

FAX 442-2819


Head Start/ECEAP

1600 Maple Street

PO Box 3010

Longview, WA 98632


Head Start/ECEAP

1600 Maple Street

PO Box 3010

Longview, WA 98632


Head Start/ECEAP

1600 Maple Street

PO Box 3010

Longview, WA 98632


Head Start/ECEAP

1600 Maple Street

PO Box 3010

Longview, WA 98632

ERSEA 1c

(C: 08/99; R: 05/18)

Lower Columbia College Head Start/ECEAP/EHS No Income Statement

Child’s Name

Parent(s) Name My basic needs (food, shelter and utilities) have been met for the last 12 months in the following ways:

Food

Shelter

Transportation

Utilities

Insurance

Household Needs

Other

I certify that the information contained in this affidavit is complete and accurate to the best of my knowledge. I understand that if I knowingly give false information or misrepresentation of my income, it may result in disqualification from the program. Signature Date signed

Signature Date signed

ERSEA 1c

(C: 08/99; R: 04/11)

LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP

Verification of Undocumented Income

This form is to be completed and signed by the parent or guardian who is unable to provide the

regular income verification documents:

Income Tax form for the previous year;

W-2 forms for the previous year;

Public Assistance--TANF (Temporary Assistance for Needy Families) TANF benefits or

services include: cash payments, job training, vouchers, transportation and subsidized

child care, such as Working Connections Child Care (WCCC).

SSI (Supplemental Security Income);

Unemployment history;

Social Security statement for 12 months;

Financial Aid.

My family’s source of income has been provided in the following way for the past year.

What are your living arrangements and/or employment status?

Who provides food and shelter for your family?

_________________________ _________________________ Signature of Parent or Guardian Child’s Name _________________________ _________________________ Signature of Staff Member Date

Verification of Undocumented Income ERSEA 1c

(R: 04/11; C: 08/99)

LOWER COLUMBIA COLLEGE HEAD START/EHS/ECEAP

Verificación de Ingresos sin Comprobante

Esta forma deberá ser llenada y firmada por el Padre de Familia o Tutor que no puede

proporcionar los documentos regulares de verificación de ingresos.

Forma de los Impuestos del año anterior;

Forma W-2 del año anterior;

Asistencia Pública--TANF (Temporary Assistance for Needy Families) beneficios de

TANF o servicios incluidos como: pagos en efectivo, capacitación para empleo, vales,

transportación o ayuda para la guardería, tal como Working Connections Child Care

(Pago para la Guardería de sus Hijos).

SSI (Seguridad de Ingreso Suplementario);

Comprobantes de desempleo;

Informe del Social Security (Seguro Social) de los últimos 12 meses;

Ayuda financiera a estudiantes

La fuente de ingresos para mi familia durante el año pasado, fue de la siguiente manera.

¿Cuál fue su situación de vivienda y/o empleo?

¿Quién proporciona alimentación y vivienda para su familia?

_________________________ _________________________ Firma del Padre o Tutor Nombre del Niño _________________________ _________________________ Firma del Personal Fecha

ERSEA 1d1

(C: 06/04; R: 05/17)


Parent/Guardian Permission to Reveal or Obtain Confidential Information Form Procedure

Parent/guardians will be requested to complete Parent/Guardian Permission to Reveal or

Obtain Confidential Information forms ERSEA 1d (Release of Information forms) for their

student’s:

Current School District;

Primary Health Care Provider; and

Dentist

Parent/guardians will also be requested to complete releases for other applicable educational

and/or health/social services agencies their student currently or previously received services

from.

Completion of Parent/Guardian Permission to Reveal or Obtain Confidential Information

forms will primarily occur during:

Look to see what is in cp.net under the enrollment tab. In right hand corner, view the

attachments (#). Click on attachments. It will list the attachments (ROIs). You can then

click on the ROI and view it or print it.

A release that was completed in the spring (April-May 2017) does not need to be

recompleted until it expires.

For Spanish language families, have the parent/guardian sign the ROI in Spanish on one

side and English on the other side.

Scheduled Intake Appointments; and

New releases must be completed at the Welcome Visits of Returning students regardless

of the expiration dates of releases already on file.

Early Head Start Intake/Enrollment Visits and First Visits for new program year.

During the school year, as the ongoing needs and/or providers of services change for a student,

parent/guardian may be requested to complete additional release(s).

Placement of Parent/Guardian Permission to Reveal or Obtain Confidential Information

form is an original and copy:

Send the original to the Program Assistant.

If DST staff obtains the original ROI, they will place a copy in the red working file prior

to sending the original to the Program Assistant. The copy will be shredded upon return

of the original.

The Program Assistant will database into the health module of ChildPlus.net; initial and

date bottom corner of original ROI; scan and attach the original ROI into the enrollment

module of ChildPlus.net; and send the original to the DST.

The original is placed in the site file.

Use of The Parent/Guardian Permission to Reveal or Obtain Confidential Information

form:

At the request of the parent/legal guardian and/or an appropriate staff member, staff will

print a copy of the pertinent ROI from the database and attach to the request.

ERSEA 1d1

(C: 06/04; R: 05/17)

The exchange of information is for the purpose of supporting the ongoing care of the

student.

Releases and Mental Health:

Intake and Welcome Visits: We won’t be automatically requesting for parents to initial

and sign the mental health line on releases at intake or initial visits. (Primary Care

Physician or School District releases)

Unusual Expectations: If the individual or guardian responsible for signing for the child

requests that we coordinate with a Mental Health Provider at intake or initial visit or asks

us to help them in setting up something related to a mental health referral, we would need

a release and for them to initial the mental health line.

Document that they discussed this desire in the intake notes or family services notes and

any additional information they shared with any specific requests. The mental health

consultants will document in the mental health module.

Referrals for Observations or to Assist in Making a Mental Health Referral: When

making a referral for an individual observation, we will request that the person/guardian

sign a release related to Mental Health if there is treatment or records they would like to

have considered or that needs to be considered in order to develop supportive strategies.

The Family Advocate or Child/Family Development Specialist or Mental Health

Consultant may request records specific to Mental Health when an observation is

occurring and share, with the child’s parent/guardian, that this information will be kept

confidential and document that they have done this in a family services note or mental

health module. If a person/family has questions about how their Mental Health

information may be used/shared/coordinated, the Mental Health Consultant is available to

follow-up and answer some questions.

Staff may also follow up with mental health consultants about questions related to

providing informed consent.

ERSEA 1d

LOC ID __________

Lower Columbia College Head Start/EHS/ECEAP (C: 04/03; R: 05/17)

PO Box 3010 – Longview, WA 98632 360-442-2800 FAX 360-442-2819

Email: [email protected]


Parent/Guardian Permission to Reveal or Obtain Confidential Information

Please complete this form with ALL information.

Child's Name: DOB:

Address: Phone:

City/State:

I hereby authorize Lower Columbia College Head Start/EHS/ECEAP to provide/receive information

to/from the following individual/agencies:

Name of Individual/Agency:

Address: Phone:

City, State, Zip: Fax #:

My authorization is for the use and disclosure of the following information: ___ Immunizations ___ Record of Health Care Provider Visits ___ Physical Exam ___ Statements of Charges & Payments

___ Medication ___ Lab Reports

___ Surgery ___ Reports of x-rays & Other Images

___ Dental ___ Educational

___ Mental Health (_____ initials) ___ IEP

___ Screening/Assessment ___ IFSP ___ AIDS (Acquired Immunodeficiency Syndrome) or HIV (Human Immunodeficiency Virus) information

___ Other: ___ All of the above

My authorization pertains to information generated on the following date(s) or in the following

time period:

Released in the following manner: Copies by mail Copies by email Copies by fax Copies to be picked-up

Chart Review by RN Health Consultant Other:

All methods listed

My authorization is given freely with the understanding that:

I may refuse to sign this permission form and my refusal will not adversely affect my enrollment.

I may revoke this authorization at any time in writing, except where information has already been

released based upon my prior authorization.

A photocopy or fax of this authorization is as valid as the original.

Lower Columbia College Head Start/EHS/ECEAP, its director, officers, employees and agents

are hereby released from any legal responsibility or liability for disclosure of the

above information to the extent indicated and authorized herein.

This information will be used for the following purpose:

At the request of the parent/legal guardian and/or Lower Columbia College Head

Start/EHS/ECEA Program for ongoing care.

I understand that the information used or disclosed pursuant to this authorization may be subject to re-disclosure

and no longer protected under federal law. However, I also understand that federal or state law may restrict

re-disclosure of HIV/AIDS information, mental health information and genetic information. This authorization

expires 18 months from the date of signing unless revoked or otherwise specified above.

Parent/Legal Guardian's Name (Please Print) Child's Name (Please print)

Parent/Legal Guardian's Signature Date Relationship to Child

Permission to Reveal or Obtain Confidential Information ERSEA 1d

LOC ID __________

Lower Columbia College Head Start/EHS/ECEAP (C: 04/03; R: 05/17)

PO Box 3010 – Longview, WA 98632 360-442-2800 FAX: 360-442-2819

Email: [email protected]


Autorización de los Padres/Tutores para Revelar u Obtener Información Confidencial

Por favor, complete esta forma con TODA la información.

Nombre del niño: Fecha de Nacimiento:

Domicilio: Número de teléfono:

Ciudad/Estado:

Por medio de la presente autorizo al Lower Columbia College Head Start/EHS/ECEAP a proporcionar y/o recibir

información a/de la siguiente persona/agencia:

Nombre de la persona/agencia:

Domicilio: Teléfono:

Ciudad, Estado, C. Postal: Fax #:

Mi autorización es para el uso y /o revelación de la siguiente información:

____ Vacunas ____ Registro de las visitas al Doctor

____ Exámenes Médicos ____ Estados de cuenta de costos y pagos

____ Medicamentos ____ Reportes de laboratorio

____ Cirugías ____ Reportes de Rayos X y otras imágenes

____ Dental ____ Educacional

____ Salud Mental (_______ iniciales) ____ Plan Individual de Educación (IEP)

____ Exámenes/Evaluaciones ____ IFSP

____ SIDA (Síndrome de Inmunodeficiencia Adquirida) o HIV (Human Immunodeficiency Virus)

____ Otros: ___________________________ ____ Todos los listados

Mi autorización corresponde a la información generada en las siguientes fechas o durante el siguiente período de

tiempo:

La información podrá ser proporcionada de la siguiente manera:

Copias por correo Copias por email Copias por fax Las copias deberán ser recogidas

Expediente revisado por la RN Consejera de Salud Otras:

Todas métodos listados

Mi autorización es otorgada libremente con el entendimiento de que:

Puedo negarme a firmar este permiso.

Puedo revocar esta autorización por escrito en cualquier momento, excepto cuando la información ya se haya dado

con base en mi anterior autorización.

Una fotocopia o fax de esta autorización es tan válida como una original.

El Head Start/EHS/ECEAP del Lower Columbia College, su director, funcionarios, empleados y agentes son

liberados de cualquier responsabilidad legal u obligación por la revelación de la información anteriormente indicada

y autorizada.

Esta información será usada para el siguiente propósito:

A petición del Padre/Tutor Legal y/o el Programa del Head Start/EHS/ECEAP del Lower Columbia College

para la atención acordada.

Yo entiendo que la información usada o revelada conforme a esta autorización quizá sea sujeta a mayor revelación y que ya

no esté protegida bajo las leyes federales. Sin embargo, yo también entiendo que las leyes federales o estatales quizás

restrinjan la revelación de información acerca de HIV/AIDS, información de salud mental e información genética. Esta

autorización se vencerá 18 meses después de la fecha en que se firmó, a menos que se cancele antes o se especifique otra

fecha más arriba.

Nombre del Padre/Tutor Legal (Por favor, escríbalo) Nombre del Niño (Por favor, escríbalo)

Nombre y firma del Padre/Tutor Legal Fecha Relación con el niño

NEW FORM ERSEA 1e


CHANGE OF STATUS

(to be completed by staff)

Original: Site File Copies: Main Office, Emergency Notebook, and Bus (if applicable) (C: 06/01; R: 07/14)

Child’s Name:

Child’s Name:

Parent’s Name:

Address:

City:

(Please Circle: ADD or DELETE or CHANGE) Phone:

Home

Cell

Cell Phone Provider

Wireless Provider

Work

Email Address

Other

( ) Child ( ) Parent

Change From:

Change To:

(Please Circle: ADD or DELETE or CHANGE)

Child's Health Insurance:

Parent/Guardian Signature Date

*Is the Parent a Policy Council Representative/

Alternative/ Officer Yes / No (circle one)

LOC ID # Birthdate:

LOC ID # Birthdate:

Staff Name: Date:

Withdraw Date:

Reason for Withdrawal:

Put Back On Wait List? Yes No

If Yes, Model or Site Requested: AM / PM


1. Name:

Relation to Child:

Address:

Phone: Home

Cell

Work


2. Name:

Relation to Child:

Address:

Phone: Home

Cell

Work


3. Name:

Relation to Child:

Address:

Phone: Home

Cell

Work

*Does the student ride a bus? Yes/ No (circle one)

(If “yes”, provide copy to bus driver for phone, address, or

emergency contact changes)

FAMILY ADDRESS/PHONE

LEGAL NAME CHANGE

HEALTH INSURANCE

OTHER - i.e., Custody Information, Restraining

Orders, Additions to Family, etc.

WITHDRAW

STUDENT EMERGENCY CONTACT

ERSEA 1f

Lower Columbia College Head Start/EHS/ECEAP (C: 11/13)

PO Box 3010 – Longview, WA 98632 360-442-2800 FAX 360-442-2819


Adult Permission to Reveal or Obtain Confidential Information

Please complete this form with ALL information.

Adult Name: DOB:

Address: Phone:

City/State:

I hereby authorize Lower Columbia College Head Start/EHS/ECEAP to provide/receive information

to/from the following individual/agencies:

Name of Individual/Agency: _____________________________________________________________

Address: ______________________________________________ Phone: ___________________

City, State, Zip: ________________________________________ Fax #: ____________________

My authorization is for the use and disclosure of the following information: ___ Immunizations ___ Record of Health Care Provider Visits ___ Physical Exam ___ Statements of Charges & Payments

___ Medication ___ Lab Reports

___ Surgery ___ Reports of x-rays & Other Images

___ Dental ___ Educational

___ Mental Health (_____ initial) ___ IEP

___ Screening/Assessment ___ AIDS (Acquired Immunodeficiency Syndrome) or HIV (Human Immunodeficiency Virus) information

___ Other: _______________________ ___ All of the above

My authorization pertains to information generated on the following date(s) or in the following

time period: __________________________________________________________________________

Released in the following manner: Copies by mail Copies by fax Copies to be picked-up

Chart Review by RN Health/RDH Dental Consultant Other:

All methods listed

My authorization is given freely with the understanding that:

I may refuse to sign this permission form.

I may revoke this authorization at any time in writing, except where information has already

been released based upon my prior authorization.

This authorization will expire on: _____________________________________________ A photocopy or fax of this authorization is as valid as the original.

Lower Columbia College Head Start/EHS/ECEAP, its director, officers, employees and

agents are hereby released from any legal responsibility or liability for disclosure of the

above

information to the extent indicated and authorized herein.

This information will be used for the following purpose:

At the request of the parent/legal guardian and/or Lower Columbia College Head

Start/EHS/ECEA Program for ongoing care.

I understand that the information used or disclosed pursuant to this authorization may be subject to re-disclosure

and no longer protected under federal law. However, I also understand that federal or state law may restrict

re-disclosure of HIV/AIDS information, mental health information and genetic information.

Name (Please Print)

Signature Date

ERSEA 2a

(C: 08/98; R: 03/18)


Attendance and Meal Count Procedure

Instruction for ChildPlus Report 2315:

1. Fill in the “Attendance for” blanks at the top of the form.

2. The five columns reflect Monday through Friday. Use the appropriate column for the day of

the week. If you are not in session on Monday and/or Friday, write “N” to indicate a non-

scheduled day. Include the date next to the name of each day of the week.

3. If you enroll a child after the first day of the week, add their name to the bottom of the list.

At the beginning of the following week, the new child’s name will appear on your next Daily

Attendance and Meals Worksheet.

4. Program office staff will email new “Daily Attendance and Meals Worksheets” at the end of

each week to the lead teacher and Area Manager in preparation for the following week.

5. CIRCLE the Breakfast (B), Lunch (L), or PM Snack (P) area after the toddler or preschool

child is seated, the meal is served and the child has been offered each food component at

least twice. (Infant meals must be counted on the Daily Infant Meal Record, ERSEA 2b1.)

6. REFER to the legend on the top of the form to accurately record the child’s attendance and

meals.

7. Add up the totals at the bottom of the page for each area (i.e. those present, eating breakfast,

lunch or snack). For accuracy, recheck by adding totals a second time and verifying that

appropriate meals are selected.

8. The original attendance form is to be routed to Program Coordinator (CM) and a copy to

your supervisor. Please make a second copy to remain at your site. Attendance/Meal Forms

are due each Friday at 5:00PM. Program office staff will enter attendance into a tracking

database for monthly reporting of child, class and site and program percentages by month.

9. If attendance falls below 85% for the month for classroom and/or individual child, staff and

Area Managers must analyze the attendance concerns. See Attendance Policy & Procedure

in ERSEA Section of Volume I Handbook for further directions on this procedure.

EHS Attendance Tracking:

Home Base: Attendance percentages, for the Home Base model (HB1, HB2, HB3, HB4

and HB5) are based upon Home Visits only that are tracked on ChildPlus EHS Tracking

Event Attendance and Prenatal Attendance Tracking Form ERSEA 2e2. EHS Area

Managers calculate the attendance percentages. They include them on their End of

Month reports.

PAL: PAL attendance and meal counts are tracked separately on ChildPlus Report 2315

and are not included to calculate attendance percentages. (USDA requires that infant

meals are also recorded on Daily Infant Meal Record forms.)

ERSEA 2a

(C: 08/98; R: 03/18)

Teen Model (EHS/Even Start): The Teen model tracks attendance and Home Visits in

ChildPlus EHS Tracking Event Attendance and Prenatal Attendance Tracking Form

ERSEA 2e2. Meal counts are recorded and tracked by Even Start staff members, on a

separate form, for USDA reimbursement by the Longview School District. Attendance

percentages are based upon classroom attendance by children and on completed Home

Visits with enrolled expectant mothers. The EHS Supervisor will receive copies of

completed ERSEA 2e2 forms monthly with EOM report. The EHS Area Managers

calculate the attendance percentages. They include them on their End of the Month

reports.

ERSEA 2b1

(C: 08/10; R: 09/17)

Lower Columbia College Early Head Start Daily Infant Meal Record

BIRTH THROUGH 5 MONTHS BREAKFAST AM SNACK LUNCH PM SNACK

NAME IFIF and/or B Milk – 4-6 oz. IFIF and/or

B Milk – 4-6 oz. IFIF and/or B Milk – 4-6 oz.

IFIF and/or B Milk – 4-6 oz.

IFIF/B Milk IFIF/B Milk IFIF/B Milk IFIF/B Milk




6 THROUGH 11 MONTHS BREAKFAST AM SNACK LUNCH PM SNACK

NAME IFIF and/or B Milk 6-8 oz.

IFIC 0-4 T and/or

Meat/Alt 0-4 T

Fruit and/or Veg

0-2 T


F/V 0-2T Grain 0-2 T or 0-1/2 slice or 0-2 crackers

IFIF and/or B Milk

6-8 oz.

IFIC 0-4 T and/or

Meal/Alt 0-4 T

Fruit and/or Veg

0-2 T


F/V 0-2 T Grain 0-2 T or 0-1/2 slice or 0-2 crackers

IFIF/B Milk

IFIF/B Milk F/V ___________ Grain __________

IFIF/B Milk

IFIF/B Milk F/V ____________ Grain ___________

IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


IFIF/B Milk


Date:

Meal Counts: Breakfast AM Snack Lunch PM Snack

*Instructions on Page 2

ERSEA 2b1

(C: 08/10; R: 09/17)

Instructions: List name of the infant consuming the meal. Circle IFIF or B Milk when offered. Record the specific food items(s) when offered (for example type of fruit, vegetable, etc.). Indicate when a parent has provided a food. All required components must be offered when the infant is developmentally ready. Record a meal or snack when:

Center supplies all components

Parent/guardian supplies only one (1) component Expressed breast milk is only component Parent supplies breast milk or IFIF and center provides all other foods

Reminders: Acronyms: Institutions are required to provide at least one (1) type of formula. IFIF = Iron Fortified Infant Formula You can only claim 2 meals and 1 snack OR 1 meal and 2 snacks per infant, per day. B Milk = Breast Milk Label parent-provided foods with a “P”. IFIC – Iron Fortified Infant Cereal

Birth through 5 months 6 through 11 months

Bre

akfa

st/L

un

ch/S

up

per

4-6 fluid ounces breastmilk or formula

6-8 fluid ounces breastmilk or formula;

AND 0-4 tablespoons infant cereal, meat, fish, poultry, whole egg, cooked dry beans, or cooked dry peas; or

0-2 ounces of cheese; or

0-4 ounces (volume) of cottage cheese; or

0-4 ounces of ½ cup of yogurt; or a combination of the above;

AND 0-2 tablespoons vegetable or fruit, or a combination of both

Birth through 5 months 6 through 11 months

Snac

k

4-6 fluid ounces breastmilk or formula

2-4 fluid ounces breastmilk or formula;

AND 0-½ slice bread; or

0-2 crackers; or

0-4 tablespoons infant cereal or ready-to-eat breakfast cereal; AND

0-2 tablespoons vegetable or fruit, or a combination of both

ERSEA 2c

1 (C: 06/03; R: 08/17)

Lower Columbia College Head Start/ECEAP

Attendance Policy and Procedure

Policy

Lower Columbia College Head Start/ECEAP will follow the Federal and State Performance

Standards, which require that Head Start/ECEAP programs analyze the causes of absenteeism

when the monthly average daily attendance rate falls below 85% in each classroom and/or for

each individual child. This analysis must include a study of the pattern of absences for each

child, including the reasons for absences as well as the number of absences that occur on

consecutive days.

Procedure

1. Staff Strategies to Promote Attendance

Inform parents of the benefits of regular attendance and about attendance/absence

procedure at first home visit, orientation and as needed to notify the center when a

child will be absent.

Provide parents with information about the benefits of regular attendance throughout

the year.

Support families to promote the child’s regular attendance.

Make direct contact or conduct a home visit with a child’s parent if a child has two

unexplained absences.

Analyze individual child attendance monthly and develop strategies to improve

individual attendance such as direct contact with parents or intensive case

management as necessary.

2. Attendance Procedures for Parents to be Notified

Parents will be expected to call or email if the child cannot attend the program on a

school day. The explanation will include why the child cannot attend and when the

child will return (if known). All absences are to be documented in case management.

The following shall be considered excused absences:

Hospitalization

Illness

Communicable disease

Death in the family

Medical and dental appointments/treatment

Family situations

Social services appointments

If a child is unexpectedly absent and a parent has not contacted the program within

one hour of program start time, staff will contact the parent/guardian to determine the

reason for absence in order to ensure the child’s safety and well-being.

Children are expected to arrive on time and be picked up on time. Parents need to

call if their child will be late to class and/or if they will be late picking the child up.

If the child is not picked up within one hour of the scheduled ending class time, and

staff cannot reach an alternate care provider from the Family Information

Form/ChildPlus, staff will be required to notify an immediate supervisor, which may

result in notification of Child Protective Services (CPS). This may result in the child

being turned over to a CPS worker and/or police officer.

ERSEA 2c

2 (C: 06/03; R: 08/17)

Parents will be expected to notify staff if someone besides themselves will be picking

up the child. No child will be released to a person not authorized by the parent to

pick-up the child. Staff must be notified (in person or by telephone) when a person

not listed on the Family Information Form/ChildPlus, will be picking up the child.

Identification of this person must be reviewed by staff before releasing the child. If

the family does not have a telephone or is otherwise hard to reach, the staff will then

attempt to contact the family at their place of residence or through emergency

contacts.

If a child ceases to attend, the program must make appropriate efforts to reengage the

family to resume attendance. If the child’s attendance does not resume, then the

program must fill the slot with a new student.

3. Staff Attendance Documentation a. Attendance will be reviewed and documented in case management by the staff as

absences occur. Attendance percentages per child will be entered into the attendance

event in ChildPlus monthly. Teachers will turn in Attendance/Meal Count sheets

weekly to the Program Coordinator.

b. If the family does not have a telephone or is otherwise hard to reach, the staff will

then attempt to contact the family at their place of residence or through emergency

contacts.

c. Attendance will be reviewed and documented in case management by the staff as

absences occur. Attendance percentages will be entered into the attendance event in

ChildPlus monthly.

4. Absences

a. If a child has two consecutive unexplained absences or if an individual child’s

attendance has fallen below 85% the following steps will be taken:

a. Staff will conduct a home visit with the child’s parent/guardian.

b. Staff will use the attendance data to support their concern and provide family

support as needed. All contacts will be noted in case management including

the agreed upon return date.

c. If the child doesn’t return to regular attendance based on the agree date at the

home visit, irregular attendance will be discussed with the Area Manager

immediately. Next steps will be documented in case management.

d. For children who are out due to surgery or lengthy illness, the staff will

provide the parent with a parent/child activity packet to be completed at home.

e. The staff will contact the Area Manager for additional support as needed.

5. Failure to Establish Regular Attendance

If attendance falls below 85% for two consecutive months or does not become regular

within 7 school days, and intensive family support efforts to improve attendance have

been made; or contact cannot be made with the parent, or cooperation cannot be

elicited from the parent/guardian the following steps will be taken:

a. The staff will inform the Area Manager of the continued absence and draft a

letter.

b. If there is no response from the parent within the timeframe of the letter, the

family will be withdrawn on the 7th day from the program.

c. The staff will complete a Child-Family File Transfer Checklist (FS/PI 7k)

when a family is withdrawn from the program and will request that the

ERSEA 2c

3 (C: 06/03; R: 08/17)

ERSEA Team place the family back on the waitlist unless the family requests

otherwise. Referrals may be made to other community services.

d. The child’s site file will accompany the completed Child-Family File

Transfer Checklist (FS/PI 7k) and be sent to the ERSEA Team at the main

LCC office.

e. Extended Absence – If a family situation results in an absence lasting more

than two weeks and following discussion with Area Manager, the child could

be placed back on the waiting list. Upon return, the child will be placed in a

classroom if space is available. All correspondence needs to be documented

in case management.

6. Classroom Attendance falls below 85% and/or individual child attendance falls

below 85% a. The analysis will include at a minimum the following:

Review the Attendance and Meal Count Forms for the month and

ensure all absences are documented in case management.

Review individual pattern of absences for each child, including

reasons and numbers of absences occurring on consecutive days.

Review any closure days or scheduled day off in the month.

Review any transportation concerns (i.e. bus not operating).

Review homelessness for any enrollment needs.

Review of communicable disease trends/concerns.

b. Staff is to review the ChildPlus report #2305 that gives the classroom attendance

percentage as well as individual child attendance by percentage.

c. For each child below 85% attendance, run a ChildPlus report #4110 for the

Attendance event only. Analyze the documentation and ensure specific reasons

for absences, communication with parents, and specific steps needed to improve

attendance are documented. Follow-up with parents as needed and document

your communication.

d. Once documentation is current, print the reports #2305 and #4110 (for Attendance

event only) and submit to Area Manager.

e. The Area Manager will review the reports and follow-up with staff as needed.

Area Managers document written updates/clarifications/action steps on the #4110

reports as needed and file with monitoring.

This policy complies with Head Start Performance Standard 1305.8 (a) (b) (c)

ERSEA 2e1

(C: 04/12; R: 12/13) Key: C= Visit Completed MV= Make Up Visit MVD= Make Up Visit Declined E= Enrollment Date NS= No Show X= Parent Cancelled SC= Staff Cancelled W/D= Withdrawn

Lower Columbia College Early Head Start EHS Attendance Tracking Form

Month: LOC ID:

Child’s Name

Week 1 Date

Week 2 Date

Week 3 Date

Week 4 Date

Week 5 Date

PAL Date Total

ERSEA 2e2

(C: 04/12; R: 12/13)

Monday Tuesday Wednesday Thursday Friday

Prenatal Topics

Date

Benefits of Breast Feeding _____

Dental Care _____

Depression/Mental Health _____

Family Planning _____

Fetal Development _____

Labor and Delivery _____

Nutrition _____

Post Partum Health Care _____

Prenatal Health Care _____

SIDS _____

Substance Abuse

Prevention _____

Actual Date of Delivery

________________________

Edinburgh Date Completed

pre ________ post ________

High Risk Pregnancy? Y N

Date Diagnosed: __________

Concerns/Risk ____________

_____________________________

_____________________________

______________

_____________________________

___________________

# Visits Complete: _________

# Visits Cancelled: _________

FPA Updated: ____________

Transition from Prenatal Mom to

Baby _________________

Month: ________________________ Year _____________ Prenatal Mom’s Name:

Due Date:

Lower Columbia College Early Head Start

Prenatal Attendance Tracking Form (EOM)

Key: C= Visit Completed MV= Make Up Visit MVD= Make Up Visit Declined E= Enrollment Date

NS= No Show X= Parent Cancelled SC= Staff Cancelled W/D= Withdrawn

LOC ID:

ERSEA 2e

1 (C: 07/10; R: 06/16)


Attendance Policy and Procedure

EHS HOME BASE HOME VISIT GUIDANCE REGARDING MISSED HOME VISITS

Schedule families at the beginning of the week whenever possible. Home visits must be

done with the parent/guardian. If they cancel, give them the option of rescheduling for

later in the week.

Discuss what is blocking the family from attendance and brainstorm which times and

days work best. Assess the roadblocks to regular home visit completion with the family.

Discuss the importance of keeping the home visit appointments and the model they have

chosen. Remind them that the model requires a minimum of 46 weekly home visits per

year.

Discuss the importance of developing routines and that adults and children benefit from

predictability in their lives.

Try to schedule families for the same time and day, unless you are making up a visit. If

making up a visit, you can schedule more than 1 per week.

Use a planning calendar regularly on your home visits with the families.

Attendance and absences will be documented in ChildPlus.

If a family has missed two consecutive home visits for the month, and you have

attempted to make them up without success, contact family, send a form letter

documenting the attempts to contact and visit them. (Place one copy of the letter in the

family file, ERSEA 2f1.)

If family reconnects with EHS staff but attendance continues to be inconsistent, staff will

discuss with EHS Supervisor and problem-solve a plan using Home Base

Attendance/Agreement Plan with Parent/Guardian (ERSEA 2g1). EHS staff will discuss

with parent/guardian and place form in child’s file, copy sent to EHS Supervisor.

Drop by the home to try to speak to the family personally. Give them one week to

contact you.

If there is no contact, we will fill their spot with a family from the waiting list.

If there is contact with the family, we will discuss the results with the

EHS Supervisor. An individual plan will be made with each family dependent upon

circumstances to maintain successful attendance.

For families discontinuing services, send a final letter notifying the family that they are

officially dropped from the home based program and that they can call the main office to

be put back on the waiting list for other programs that will better fit their needs. (Copy of

letter placed in family file).

EARLY HEAD START COMBINATION AND

FULL DAY/FULL YEAR (FDFY) TEEN PROGRAM

1. Early Head Start (EHS) Staff Notification

Parents will be informed upon enrollment and reminded periodically to notify the

EHS Staff and center when their child will be absent.

ERSEA 2e

2 (C: 07/10; R: 06/16)

Parents will be expected to call if their child cannot attend the program on a school

day. The explanation should include why the child cannot attend and when the child

will return, if known. All absences excused or not are to be documented in ChildPlus.

The following shall be considered excused absences:

Hospitalization

Illness

Communicable disease

Death in the family

Emergency medical treatment

Family situations

Social Service appointments

Parents will also be expected to call if their child will be late to class and/or if they

will be late picking the child up from class. Children are expected to arrive on time

and be picked up on time. If the child is not picked up within one-hour of the

scheduled ending class time, and staff cannot reach an alternate care provider from

the Family Information Form, staff will be required to notify the EHS Supervisor,

which may result in notification of Child Protective Services (CPS).

Parents will be expected to notify staff if someone else besides themselves will be

picking up their child from the center. No child will be released to a person not

authorized by the parent to pick-up the child. Staff must be notified (in person or by

telephone) when a person not listed on the Family Information Form will be picking

up the child. Identification of this person must be reviewed by staff before releasing

the child.

If EHS staff is not contacted about a child’s absence, the EHS staff will contact the

family on the day of the third consecutive absence. Attendance, absences and Home

Visits are recorded on the Attendance Tracking Form (ERSEA 2e1).

If the family does not have a telephone or is otherwise hard to reach, the EHS staff

member will then attempt to contact the family at their place of residence.

Attendance will be reviewed and documented on the case management form by the

EHS staff.

2. Absences

Chronic Absenteeism. If a child has three or more unexcused absences, or three

consecutive excused absences the following steps will be taken:

a. The EHS staff will contact the family to find out why the child has been

absent, and emphasize the necessity of notifying the classroom if the child is

going to be absent and what the benefits are of regular attendance.

b. The EHS staff will provide appropriate family support as needed. Irregular

attendance will be discussed with the EHS Supervisor and may result in the

development of an Attendance Agreement Plan with the parent to insure

regular attendance of the child.

c. Should a pattern of absences due to illness occur, the EHS staff will follow-up

with the family to make certain that the child has adequate health care.

d. For children who are out due to surgery or lengthy illness, the EHS staff with

the parent will write a parent/child activity plan for the child to be completed

at home.

ERSEA 2e

3 (C: 07/10; R: 06/16)

e. Documentation of absences, contacts with parents and results of conferences

are kept on the education event in ChildPlus.

Extended Absence. If a family situation results in an absence lasting more than two

weeks and following discussion with the EHS Supervisor and EHS Manager/Health

Specialist, the child could be placed back on the waiting list. Upon return, the child

will be placed in the classroom if space is available. All correspondence needs to be

documented in case management.

Failure to Establish Regular Attendance. If attendance does not become regular, and

intensive family support efforts to improve attendance have been made, the contact

cannot be made with the parent, or cooperation cannot be elicited from the parent the

following steps will be taken:

a. The EHS staff will inform the EHS Supervisor of the continued absence.

b. A letter to the parent will be sent by the EHS staff which states the problem,

offers support and gives the parents a deadline to respond to the absence

(ERSEA 2f).

c. If there is no response from the parent within the timeframe of the letter, the

family will be dropped from the program. The EHS Supervisor will make this

decision.

d. The EHS staff member will generate a Change of Status Form stating the

reasons for the drop (See Change of Status (ERSEA 1e). When a family is

dropped from the program due to attendance issues, the EHS staff will request

that the Program Coordinator place the family back on the waitlist if the

family requests or referrals may be made to other community services.

e. The child’s site file will accompany the Change of Status Form and be sent to

the Records Program Coordinator at the main LCC office.

3. Classroom Attendance falls below 85%

The EHS staff with the EHS Supervisor will discuss and analyze the causes of the

absenteeism.

The analysis and action plan will be documented on the Analyzing Attendance Form

located in the Lesson Plan Notebook.

The analysis will include at a minimum the following:

Review any closure days or scheduled days off in the month;

Review any transportation concerns (i.e. applies only to FDFY Teen program);

Review individual pattern of absences for each child, including reasons and

numbers of absences occurring on consecutive days;

Review attendance plans already in place with individual families;

Follow the Attendance Policy and Procedure for individual attendance concerns.

This policy complies with Head Start Performance Standard 1305.8 (a) (b) (c) and Memorandum

Cited (ACYF-IF-HS-00-22)

EHS Home Base Child Attendance ERSEA 2f1

(C: 07/10)

Date________________________

Dear________________________

We are sending this letter because you have missed several home visits and we have been unable

to reschedule them. The Early Head Start staff has made several attempts to contact you by

telephone or in person by leaving you a message at your home. Please contact your Child and

Family Development Specialist______________________ as soon as you receive this letter to

schedule our next visit. If the EHS staff does not hear from you by___________________, you

and your child will be put back on the waiting list and another family will be offered services in

your place.

We look forward to hearing from you.

Sincerely,

________________________ (EHS staff name)

_______________________ _ (phone number)

_________________________ (EHS Supervisor)

If I do not answer, please leave a message with your updated contact information and I will call

you as soon as I possible. Thank you.

EHS Home Base Child Attendance ERSEA 2f1

(C: 07/10; R: 07/11)

Fecha________________________

Estimada________________________

Estamos enviando está carta porque ha perdido varias visitas a su casa y no hemos podido

programar otra. El personal de Early Head Start ha hecho varios intentos para comunicarse con

usted por teléfono o en persona y le hemos dejado mensajes en su casa. Por favor comuníquese

con la Especialista de Desarrollo Infantil y Familiar tan pronto como

reciba esta carta para programar nuestra próxima visita. Si usted no se comunica con el personal

de EHS antes del , usted y su niño serán puestos nuevamente

en la lista de espera y los servicios serán ofrecidos a otra familia.

Estaremos esperando que se comunique con nosotros.

Sinceramente,

________________________ (nombre del personal de EHS)

________________________ (número de teléfono)

_________________________ (Supervisora de EHS)

Si no puedo contestar su llamada, por favor deje un mensaje con su actual información de

contacto y yo me comunicaré con usted tan pronto como me sea posible. Gracias.

EHS Home Base Unable to Contact ERSEA 2f2

(C: 06/11; R: 07/12)

Date________________________

Dear________________________

I’ve really enjoyed our visits and look forward to seeing your family again soon. Unfortunately,

I have been unable to contact you using the contact information I have on file. Please contact me

as soon as you receive this letter so we can schedule your next home visit. As a reminder, Early

Head Start requires that we meet once a week so your family can fully benefit from our program.

If you are having a hard time with this, please call me so we can talk about it.

If I do not hear from you by , your family will have to be put

back on the waiting list and another family will be offered services in your place.

(Home Visitor Name)

(Phone Number)

If I do not answer, please leave a message with your updated contact information and I will call

you as soon as I possibly can. Thank you.

3-5 Child Attendance Letter ERSEA 2f

(R: 07/10)

Fecha:

RE:

Estimado ____________________________:

El Head Start/EHS/ECEAP del Lower Columbia College ha hecho varios intentos para

contactarlo ya sea en persona o por teléfono dejándole un recado en su casa. Su niño ha estado

ausente las siguientes fechas: ______________________________________. Cuando su niño

no se presenta a la escuela por un período de tiempo y no hemos sido capaces de contactarlo o no

hemos sabido nada de usted, es una norma dar de baja a su niño y ponerlo en la lista de espera.

Por favor, póngase en contacto con nosotros al ________________________ antes del

_______________________________ acerca de la inscripción de su niño. Si nosotros no hemos

sabido nada de usted para esta fecha, se seleccionará otro niño para ocupar su lugar en el salón

de clases. Si podemos ayudarlo para el regreso de su niño a la escuela, por favor llámenos.

Atentamente,

Maestra / Personal de EHS

Trabajadora Social

Supervisora

Cc: Child Site File

ERSEA 2f

(R: 07/10)

Date:

RE:

Dear ____________________________:

Lower Columbia College Head Start/EHS/ECEAP has made several attempts to contact you

either by telephone or in person by leaving a message at your home. Your child has been absent

the following dates: ______________________________________. When your child does not

appear at school for a period of time and we have been unable to contact you or have not heard

from you, it is our policy to withdraw your child and place him/her on the waitlist.

Please contact us at ________________________ by _______________________________

regarding your child’s enrollment. If we have not heard from you by this date, another child will

be selected to fill his/her space in the classroom. If we can assist you in returning your child to

school, please call.

Sincerely,

Teacher / EHS Staff

Family Advocate

Supervisor

Cc: Child Site File

ERSEA 2g1

Distribution: Original in file Copies: 1 to parent/guardian, 1 to EHS Supervisor (C: 06/15; R: 06/16)

Lower Columbia College Early Head Start Home Base Attendance/Agreement Plan with Parent/Guardian

Child’s Name Date

Parent’s Name LOC ID

Type of Contact: Phone Personal Contact

% Attendance for month Reason for Absence:

Solution agreed upon:

Family will be placed back on waitlist.

2 consecutive missed visits at any time during the month will result in notification by mail or phone that family will be placed back on the waitlist.

Family will develop an individualized plan with EHS supervisor.

Attendance % will be discussed monthly with family.

Other

EHS Attendance Plan Follow-Up

Date Attendance Improved: Yes No % Attendance Follow-Up Notes:

Plan of Action:

No further action.

Continue with current plan for another: 3 months 6 months

Placed on waitlist: notified by mail notified in person

Develop an individualized plan with EHS Supervisor

Other

ERSEA 3a

1 (C: 03/00; R: 01/16)


Selection of Families

Policy

The Selection process will follow the federal and state income guidelines with the goal of

serving the lowest of low-income and those with the greatest need for Head Start/EHS/ECEAP

services following the Selection Criteria approved by Policy Council (see Selection Criteria

Definition ERSEA 3c).

Procedure

1. In order to obtain all necessary data essential in determining eligible children, applicants

for the Head Start/EHS/ECEAP programs will be required to fill out an application and

provide income documentation. Staff will assist parents, as needed. Applications are

accepted year round.

2. To be considered eligible for Head Start/EHS/ECEAP enrollment, the following

requirements must be met:

a. EHS eligibility is prenatal to 3 years’ old.

b. Traditional Head Start/ECEAP eligibility is 3 years old by August 31st.

c. Children must live in the Cowlitz County service area.

d. Families must meet the Head Start/EHS/ECEAP Income Guidelines based on

Federal Poverty Level.

e. Verification of income eligibility may include examination of any of the following:

Income Tax form for the previous year;

W-2 forms for the previous year;

Public Assistance – TANF (Temporary Assistance for Needy Families) or SSI

(Supplemental Security Income); TANF benefits or services include: cash

payments, job training, vouchers, transportation and subsidized child care, such as

Working Connections Child Care (WCCC);

Unemployment history from the Employment Security Office;

Social Security statement for 12 months;

A child in foster care is categorically eligible;

A homeless child is categorically eligible;

For ECEAP – A child who is on an IEP is categorically eligible regardless of

income.

f. Income eligibility will be documented on the Eligibility Verification Form (ERSEA 3b)

by the Program Coordinator. The Eligibility Verification Form notes which documents

were examined to verify income eligibility and both are placed in the child’s site file

along with the Selection Criteria Score Sheet. (See Selection Criteria Score Sheet

ERSEA 3d for 3-5 year program and ERSEA 3d1 for EHS.)

g. A 3-year old child who has been found income eligible and is participating in the

Head Start/ECEAP program remains income eligible throughout that enrollment year

and the following year. An EHS child remains income eligible until transitioning

from EHS at age 3 years as outlined in the Transition from EHS to Head Start /

ECEAP or Appropriate Placement. A child transitioning from EHS to the 3 – 5 year

program must reapply and provide current income verification.

ERSEA 3a

2 (C: 03/00; R: 01/16)

h. A child who is applying for enrollment who resides outside of Cowlitz County must

have permission in writing from the director of their local Head Start/ECEAP

program and will only be considered after exhausting all income eligible children on

the waitlist.

i. When the waitlist is exhausted of all income eligible and categorically eligible

families, Head Start/EHS families who have incomes within 100 – 130% of the

Federal Poverty Level are contacted for enrollment following the selection criteria.

3. Once a child’s family income has been verified the application will be processed through

the Selection Criteria established by the program to give priority to those who are in most

need of Head Start/EHS/ECEAP services. The Selection Criteria gives points for the

following areas: (See Selection Criteria Form ERSEA 3d and/or ERSEA 3d1 for the

number of points given)

a. Parental Status;

b. Disability;

c. Income;

d. Age;

e. Prior status;

f. Need.

4. Requests for transfer within the Head Start/EHS/ECEAP program (because of a change in

the family’s living, working or childcare arrangements) will be given top priority by

following the Request for Change of Classroom (MSYS 7p) procedure set up in

connection with the Content Expert Team.

5. Vacancies will be filled as soon as possible not to exceed 30 days.

a. The intake team member will contact the first family on the waitlist to determine

if the family would like to accept the vacancy.

b. In rare cases, the intake team member (in consultation with the Content Expert

Team) may move to the next child on the waitlist due to age and/or emergent

need. Documentation regarding reasons for this exception will be noted.

6. Over-income children will be placed on the waiting list following any income-eligible

children, and will be considered only if no income-eligible children are on the waiting

list.

7. The Intake Team will contact selected families to complete an enrollment intake. Letters

will be sent to those who remain on the waitlist in September/October. (See Enrollment

Policy and Procedure ERSEA 3c)

Policy complies with Performance Standard 1305.6

Selection of Families ERSEA 3a

(C: 03/00; R: 01/16)


Selección de Familias

Política

El proceso de Selección seguirá las pautas federales y estatales acerca de los ingresos, con la meta de

servir a las familias que tengan los ingresos más bajos entre el grupo de familias de ingresos bajos y a las

que tengan más necesidad de los servicios del Head Start/EHS/ECEAP según el Criterio de Selección

aprobado por la Mesa Directiva (ver la Definición de Criterio de Selección ERSEA 3c).

Procedimiento

1. Con el fin de obtener todos los datos esenciales para determinar cuáles de los niños son elegibles,

se les requerirá a los solicitantes al programa Head Start/EHS/ECEAP que completen una

solicitud y provean documentación de sus ingresos. El personal ayudará a los padres como sea

necesario. Las solicitudes se aceptan durante todo el año.

2. Para ser consideradas como elegibles para la inscripción en los programas Head

Start/EHS/ECEAP, las familias necesitan cumplir con los siguientes requisitos:

a. Los niños son elegibles para el EHS desde el período prenatal hasta los 3 años de edad.

b. Los niños son elegibles para el programa tradicional Head Start/ECEAP si tienen 3 años

de edad el 31 de agosto.

c. Los niños tienen que vivir en el área de servicios del condado Cowlitz.

d. Las familias tienen que cumplir con las Pautas de Ingresos del programa Head

Start/EHS/ ECEAP, basadas en el Nivel Federal de Pobreza.

e. La verificación de elegibilidad por los ingresos puede incluir la examinación de cualquier

de los siguientes:

El formulario de impuestos sobre la renta del año anterior.

Formularios W-2 del año anterior.

Asistencia Pública—el TANF (asistencia temporal para las familias necesitadas) o el

SSI (ingresos suplementarios de seguridad); los beneficios del TANF incluyen: pagos

en efectivo, capacitación para el trabajo, vales, transporte y subsidios para la guardería,

como el WCCC (“Working Connections Child Care” o cuidado de niños con

conexiones con el trabajo)

Historial de desempleo de la Employment Security Office (oficina de seguridad de

empleo);

Declaración de Seguro Social, mostrando los beneficios de 12 meses

Un niño que esté en un hogar de acogida es categóricamente elegible;

Un niño sin hogar es categóricamente elegible;

Para el programa ECEAP—un niño que tenga un IEP (plan de educación

individualizada), es categóricamente elegible sin importar los ingresos de su familia.

f. La elegibilidad por los ingresos será documentada en el Formulario de Verificación de

Ingresos (ERSEA 3b) por el Coordinador de Programa. Los documentos que fueron

examinados para verificar su elegibilidad por los ingresos son registrados en el

formulario de verificación de elegibilidad. Los documentos examinados, el formulario de

verificación de elegibilidad y la Puntuación del Criterio de Selección se colocan en el

expediente del niño. (Ver la Puntuación del Criterio de Selección ERSEA 3d para el

programa de 3-5 años y el ERSEA 3d1 para el EHS.)

g. Si se ha determinado que un niño de 3 años es elegible por los ingresos de su familia y

ese niño está participando en el programa Head Start/ECEAP, ese niño se quedará

elegible por los ingresos durante todo ese año programático y durante todo el siguiente.

Un niño del EHS permanece elegible por los ingresos hasta hacer la transición del EHS a

Selection of Families ERSEA 3a

(C: 03/00; R: 01/16)

otro programa, como se describe en la política Transition from EHS to Head

Start/ECEAP or Appropriate Placement (transición del EHS al Head Start/ECEAP o a la

colocación adecuada). La familia de un niño que hace la transición del EHS al programa

de niños de 3-5 años necesita completar otra solicitud y proveer una verificación actual

de sus ingresos.

h. La familia de un niño que solicite la inscripción y resida fuera del condado Cowlitz

necesita el permiso escrito del director de su programa local del Head Start/ECEAP y el

niño sólo será considerado después que estén inscritos todos los niños de la lista de

espera que sean elegibles por los ingresos de sus familias.

i. Cuando estén inscritos todos los niños de la lista de espera que sean categóricamente

elegibles o que sean elegibles por sus ingresos, las familias del Head Start/ECEAP que

tengan ingresos dentro de 100-130% del nivel federal de pobreza serán contactadas según

el criterio de selección.

3. Después de ser verificados los ingresos de la familia de un niño, la solicitud será tramitada

siguiendo el Criterio de Selección establecido por el programa con el propósito de dar la prioridad

a las personas que más necesiten los servicios del Head Start/EHS/ECEAP. El Criterio de

Selección asigna puntos a los niños en las siguientes áreas (Ver el Formulario de Criterio de

Selección ERSEA 3d o 3d1 para ver el número de puntos otorgados)

a. Situación Familiar

b. Discapacidad

c. Ingreso

d. Edad al 31 de agosto

e. Situación Anterior

f. Necesidades

4. La más alta prioridad será dada a las peticiones de traslado dentro del programa Head

Start/ECEAP/EHS (por causa de un cambio de la situación de vivienda, el trabajo o la guardería

de una familia), siguiendo el procedimiento del formulario para solicitar un cambio de clase (el

MSYS 7p—“Request for Change of Classroom”), que es desarrollado con la ayuda del equipo de

expertos de contenido (Content Expert Team).

5. Las vacantes serán cubiertas lo más antes posible, en un plazo que no exceda 30 días.

a. El miembro del equipo de inscripciones (Intake Team) contactará a la familia que esté

más alta en la lista de espera para determinar si la familia quisiera aceptar la vacante.

b. En casos muy raros, el miembro del equipo de inscripciones (en consultación con el

equipo de expertos de contenido) puede contactar a la familia del siguiente niño debido a

la edad y/o una necesidad emergente que tenga. Se anotará la documentación sobre los

motivos de esta excepción.

6. Los niños de familias cuyos ingresos excedan los límites de ingresos serán colocados en la lista

de espera después de los niños de familias elegibles por sus ingresos y solamente serán

considerados si no hay niños en la lista de espera que sean de familias elegibles por los ingresos.

7. El equipo de inscripciones contactará a las familias seleccionadas para completar una entrevista

de inscripción. Se les mandarán cartas a las familias de niños que todavía estén en la lista de

espera en el septiembre o el octubre. (Ver la Inscripción de Familias--ERSEA 3c)

Esta política cumple con la norma de rendimiento “Performance Standard 1305.6”

ERSEA 3b1

Print on Yellow (R: 04/11; C: 04/09)

Lower Columbia College Head Start / EHS / ECEAP

Verification of Homeless Status

Homelessness means individuals who lack a fixed, regular, and adequate nighttime residence.

1. Child’s Name: ___________________________________________________________

2. Child’s date of birth: ______________________________________________________

3. Verify status. Check which category children and youths are in:

Children and youth who are sharing housing of other persons due to loss of housing,

economic hardship, or similar reason; Living in motels, hotels, trailer parks, or

camping grounds due to lack of alternative adequate accommodations; Living in

emergency or transitional shelters; Are abandoned in hospitals; or are awaiting foster

care placement;

Children and youths who have a primary nighttime residence that is a public or

private place not designed for or ordinarily used as a regular sleeping accommodation

for human beings; and

Children and youths who are living in cars, parks, public space, abandoned buildings,

substandard housing, bus or train stations, or similar settings.

Staff Signature _______________________________ Date of eligibility verification: _________________

Staff Name: ______________________________________ Title: ________________________________

ERSEA 3b

Print on Yellow (C: 04/09; R: 07/17)


Eligibility Verification

1. Child’s Name:

2. Child’s date of birth:

3. Staff conducted interview with family:

In person

By telephone

4. Verify Eligibility. Check which category of eligibility this child falls into:

Public Assistance

SSI (Head Start ONLY!)

IEP (ECEAP Only)

Homeless

Foster Care

Income

Head Start/Early Head Start:

Below federal poverty guidelines

Between 100 < 130% of Federal Poverty Guidelines (no more than 35% of

Head Start enrolled children may fall into this category)

Over-Income

ECEAP:

Below ECEAP Income Eligibility Guidelines (up to 110% of the Federal Poverty

Guidelines (FPL))

Over-Income

5. What documentation was used to determine eligibility?

Income Tax Form 1040 Written statements from employers

W-2 Foster care reimbursement

TANF documentation SSI documentation

Pay stub or pay envelopes Other

Unemployment If other, please explain:

Documentation of no income

I have carefully reviewed the documents and information that has been provided to me by the

applicant, and, by signing this form, certify to the best of my knowledge and belief that all

information regarding eligibility provided to me is true and accurate.

6. Staff Signature: Date of eligibility verification:

7. Staff Name: Title:

ERSEA 3c

(C: 09/10; R: 02/16)


Enrollment of Families

Procedure

1. Definition of Program Models

a. Home Base – Weekly home visits (1.5 hours); twice monthly Play and Learn

Groups (Socializations)

b. Full Day Teen Program with Longview School District – 5 days a week; 7 hours a

day; September to June (Summer goes to home base)

c. Pregnant Mothers – Services are provided as indicated on the individualized

Home Visit Plan form for Prenatal Families through the Family Partnership

process.

2. For the purpose of determining eligibility based on family income, the pregnant woman is

counted as two members of the household. In the case of an unmarried pregnant teen, her

own income determines her eligibility regardless of her parent’s income.

3. For the purpose of determining the number of individuals enrolled in an EHS program,

the pregnant woman is counted as the one who is enrolled. One month following the

birth of the child, it is the child who is enrolled in the EHS program. Regulations

governing Program Models do not apply to pregnant women. EHS Staff are not required

to follow the frequency and duration of home visits that are required in the Home Base

Program.

4. Upon completion of the selection process of eligible children and/or pregnant mother the

Program Coordinator will generate a child/family site file, which is given to the

appropriate EHS staff member after the enrollment intake is complete. If needed, an

interpreter will assist with the non-English speaking families.

5. Once the pregnant mother delivers the baby the EHS Staff member will add information

on the newborn to the existing EHS application. Entry in Early Head Start will not begin

until child is at least 4 weeks old.

6. A Parent Orientation will be completed on the Home Visit.

7. Once a child is selected from the waitlist and the Program Coordinator completes an

intake, the child is accepted and considered enrolled in the Early Head Start program.

8. Vacancies will be filled within 30-days following the selection criteria.

9. Children who are enrolled in EHS will remain income eligible while they are

participating in the program. When a child moves from a program serving infants and

toddlers to a Head Start program serving children age three and older, they family income

must be re-verified.

10. When an eligible child is enrolled in EHS and they reach 30 months of age, a transition

plan in implemented.

EHS Enrollment of Families ERSEA 3c

(C: 09/10; R: 02/16)


Inscripción de Familias

Procedimiento

1. Definición de Modelos del Programa

a. Home Base – Visitas semanales al hogar (1.5 horas), dos veces al mes Grupos de Juego

y Aprendizaje (Socializaciones)

b. Programa de Todo el Día para Adolecentes con el Distrito Escolar de Longview– 5 días

a la semana, 7 horas al día, Septiembre a Junio (el verano va a home base)

c. Madres embarazadas –Los servicios son provistos como es indicado en la forma del Plan

de Visitas al Hogar para Familias Prenatales a través del proceso de Asociación de la

Familia.

2. Con el propósito de determinar la elegibilidad en base al ingreso de la familia, la mujer

embarazada es contada como dos miembros en el hogar. En el caso de una adolescente soltera

embarazada, su propio ingreso determina su elegibilidad sin tener en cuenta el ingreso de sus

padres.

3. Con el propósito de determinar el número de individuos inscritos en un programa de EHS, la

mujer embarazada es contada como uno que está inscrito. Un mes de seguimiento del nacimiento

del niño, esto es el niño que está inscrito en el programa de EHS. Las Normas de gobierno de los

Modelos de Programas no se aplica para la mujer embarazada. El personal de EHS no está

obligado a seguir la frecuencia y duración de las visitas al hogar que son requeridos en el

Programa de Home Base.

4. Una vez finalizado el proceso de selección de los niños elegibles y/o madre gestante, el

Coordinador de Programa iniciará un expediente del niño/familia, el cual es entregado al

miembro apropiado del personal de EHS después que el proceso de inscripción sea completado.

Si es necesario, una intérprete apoyará a las familias que no hablan inglés.

5. Una vez que la madre embarazada da a luz, el miembro del personal de EHS añadirá información

en la solicitud existente del recién nacido. El ingreso del niño en Early Head Start no comenzará

hasta que el niño tenga al menos 4 semanas de edad.

6. La Orientación de Padres será completado en la Visita al Hogar.

7. Una vez que el niño sea seleccionado de la lista de espera y el Coordinador del Programa

completa la admisión, el niño es aceptado y considerado inscrito en el programa de Early Head

Start.

8. Las vacantes serán cubiertas dentro de los 30 días siguiendo el criterio de selección.

9. Los niños quienes están inscritos en EHS permanecerán siendo de ingreso elegible, mientras ellos

estén participando en el programa. Cuando el niño se traslada de un programa sirviendo a bebés y

niños pequeños a un programa de Head Start sirviendo a niños de edad de tres años y mayor de 3

años, el ingreso de la familia debe ser verificado nuevamente.

10. Cuando un niño elegible es inscrito en EHS y ellos alcanzan los 30 meses de edad, un plan de

transición es implementado.

ERSEA 3d1

(C: 02/10; R: 01/16)

Approved by Policy Council 02/22/2016

Attachment #7

Lower Columbia College Early Head Start (EHS)

Selection Criteria Score Sheet

PARENTAL STATUS SCORE

Two Parent Household – 20 points _____

One Parent Household – 30 points _____

Pregnant Mother – 75 points _____

Foster Parent – 60 points _____

Homeless – 60 points _____

Child lives with someone other than parent – 60 points _____

DISABILITY

Diagnosed/Documented Disability – 50 points _____

Potential/Suspected (behavioral or developmental) – 30 points _____

INCOME

00-50% of Poverty Guidelines/TANF Cash Grant/SSI/WCCC – 100 points _____

51-100% of Poverty Guidelines/TANF Non-Cash Benefits – 80 points _____

101-129% of Federal Poverty Level – 40 points _____

130% or over of Federal Poverty Level – 0 points _____

EHS AGE

Prenatal – 12 months – 100 points _____

13 months – 24 months – 75 points _____



PRIOR STATUS

Transfer in from another EHS Program – 50 points _____

On waitlist previous year – 75 points _____

Returning family within the last 3 years – 20 points _____

NEED

Child Abuse/Neglect (CPS referral) – 50 points _____

Referral from Other Agency/Professional (documented) – 30 points _____

Non-English Speaking – 30 points _____

Possible Risk Factors – 50 points Circle all that apply _____

o Substance Abuse

o Domestic Violence

o Chronic Illness in Family

o Disaster/Tragedy/Severe Trauma, etc.

o High Risk Family (mental illness, disabled)

o Serious Child Health Problems

o Incarcerated Parent/Guardian

o Child Abuse/Neglect (no referral/self reported)

o Teen Parent

Date _____________________________ Total Score _____

Staff _____________________________

EHS Selection Criteria Score Sheet ERSEA 3d1

(C: 02/10; R: 01/16)


Lower Columbia College Early Head Start (EHS)

Puntuación del Criterio de Selección

SITUACION FAMILIAR Puntuación

Hogar con dos padres – 20 puntos _____

Hogar con un padre – 30 puntos _____

Madre embarazada – 75 puntos _____

Hogar temporal (foster home) – 60 puntos _____

Sin hogar – 60 puntos _____

Niño viviendo con alguien que no sean sus padres – 60 puntos _____

DISCAPACIDAD

Discapacidad Diagnosticada/Documentada – 50 puntos _____

Potencial/Presunta (comportamiento o desarrollo) – 30 puntos _____

INGRESO

00-50% de las Normas Generales de Pobreza/TANF asignación de

efectivo/SSI/WCCC – 100 puntos _____

51-100% de las Normas Generales de Pobreza/TANF

Sin beneficios en efectivo – 80 puntos _____

101-129% del Nivel Federal de Pobreza – 40 puntos _____

130% o más del Nivel Federal de Pobreza – 0 puntos _____

EDAD EHS

Prenatal – 12 meses – 100 puntos _____

13 meses – 24 meses – 75 puntos _____



SITUACION ANTERIOR

Transferencia de otro Programa de EHS – 50 puntos _____

En la lista de espera del año pasado – 75 puntos _____

Una familia que participó en el programa en los 3 años pasados – 20 puntos _____

NECESIDADES

Abuso/Negligencia Infantil (remisión CPS) – 50 puntos _____

Remisión de otra Agencia/Profesional (documentada) – 30 puntos _____

No habla inglés– 30 puntos _____

Posibles factores de riesgo – 50 puntos Circule todos los que correspondan _____

o Abuso de Sustancias

o Violencia Doméstica

o Enfermedades Crónicas en la Familia

o Desastres/Tragedia/Trauma severo, etc.

o Familia de Alto Riesgo (enfermedad mental, discapacidad)

o Serios Problemas en la salud del niño

o Padre/Tutor Encarcelado

o Abuso/Negligencia Infantil (no remisión /auto reportado)

o Padre Adolescente

Fecha Puntuación Total _____

Personal

ERSEA 3d

(R: 01/16)


Attachment #7

Lower Columbia College Head Start/ ECEAP

Selection Criteria Score Sheet

PARENTAL STATUS SCORE

Two Parent Household – 20 points _____

One Parent Household – 30 points _____

Foster Parent – 60 points _____

Homeless – 60 points _____

Child lives with someone other than parent – 60 points _____

DISABILITY

Diagnosed/Documented Disability – 50 points _____

Potential/Suspected (behavioral or developmental) – 30 points _____

INCOME

00-50% of Poverty Guidelines/TANF Cash Grant/SSI/WCCC – 100 points _____

51-100% of Poverty Guidelines/TANF Non-Cash Benefits – 80 points (Head Start) _____

51-110% of Poverty Guidelines/TANF Non-Cash Benefits- 80 points (ECEAP) _____

101-129% of Federal Poverty Level – 40 points _____

130% or over of Federal Poverty Level – 0 points _____

AGE AS OF AUGUST 31st

4 years –100 points _____

3 years, 6 months to 3 years, 11 months – 25 points _____

3 years to 3 years, 5 months – 0 points _____

PRIOR STATUS

Transfer in from another Head Start/ECEAP Program – 50 points _____

On income eligible waitlist previous year – 75 points _____

Transitioning from Early Head Start – 75 points _____

Returning family within the last 3 years –20 points _____

NEED

Child Abuse/Neglect (CPS referral) – 50 points _____

Referral from Other Agency/Professional (documented) – 30 points _____

Non-English Speaking – 30 points _____

Possible Risk Factors – 50 points Circle all that apply _____

o Substance Abuse

o Domestic Violence

o Chronic Illness in Family

o Disaster/Tragedy/Severe Trauma, etc.

o High Risk Family (mental illness, disabled)

o Serious Child Health Problems

o Child Abuse / Neglect (no referral / self reported)

o Incarcerated Parent / Guardian

o Teen Parent

Date _____________________________ Total Score _____

Staff _____________________________

HS/ECEAP Selection Criteria Score Sheet ERSEA 3d

(R: 01/16)



Puntuación del Criterio de Selección

Puntuación

SITUACION FAMILIAR Hogar con dos padres – 20 puntos _____

Hogar con un solo padre – 30 puntos _____

Hogar temporal (foster home) – 60 puntos _____

Sin hogar – 60 puntos _____

Niño viviendo con alguien que no sean sus padres – 60 puntos _____

DISCAPACIDAD

Discapacidad diagnosticada/documentada – 50 puntos _____

Potencial/Presunta (comportamiento o desarrollo) – 30 puntos _____

INGRESO

00-50% de las Normas Generales de Pobreza/TANF asignación de

efectivo/SSI/WCCC – 100 puntos _____


Sin beneficios en efectivo – 80 puntos (Head Start) _____


Sin beneficios en efectivo – 80 puntos (ECEAP)

101-129% del Nivel Federal de Pobreza – 40 puntos _____

130% o más del Nivel Federal de Pobreza – 0 puntos _____

EDAD AL 31 DE AGOSTO

4 años – 100 puntos _____

3 años-6 meses a 3 años-11 meses – 25 puntos _____

3 años a 3 años-5 meses – 0 puntos _____

SITUACION ANTERIOR

Transferencia de otro Programa de Head Start/ECEAP – 50 puntos _____

Ingreso elegible y en lista de espera del año pasado – 75 puntos _____

Transición de Early Head Start – 75 puntos _____

Una familia que participó en el programa en los 2 años pasados – 20 puntos _____

NECESIDADES

Abuso y Negligencia Infantil (remisión de CPS) – 50 puntos _____

Remisión de otra Agencia/Profesional (documentada) – 30 puntos _____

No habla inglés – 30 puntos _____

Posibles factores de riesgo – 50 puntos Circule todos los que correspondan

o Abuso de Sustancias

o Violencia Doméstica

o Enfermedades Crónicas en la Familia

o Desastres/Tragedia/Trauma severo, etc.

o Familia en Alto Riesgo (enfermedad mental, discapacidad)

o Serios problemas en la salud del niño

o Abuso y Negligencia Infantil (no remisión/auto-reportado)

o Padre/Tutor Encarcelado

o Padre Adolescente

Fecha Puntuación Total _____

Personal

ERSEA 3e

Policy complies with Head Start Program Performance Standards, ECEAP Performance Standards,

Child Care Licensing and WAC (C: 03/00, R: 07/17)


Enrollment of Families

Policy Lower Columbia College Head Start/Early Childhood Education and Assistance Program will serve

children who will be three years old by August 31st. Ninety percent of children served will meet the Head

Start/ECEA Program income eligibility standards. A maximum of ten (10) percent of enrolled children

per funding source of Head Start/ECEAP may be over income. At least ten (10) percent of the total

number enrolled in Head Start / ECEAP will be children with disabilities.

Procedure

1. Definition of Program Models

a. Traditional (Part-day) Head Start classrooms – 3.5 hours a day, 4 days a week September to

June.

b. Traditional (Part-day) ECEAP classrooms – 3.5 hours a day, 3 or 4 days a week September to

June.

c. Full Day (6 hour) ECEAP classrooms, 5 days a week September to June.

d. Full Day (6 hour) Head Start classrooms, 5 days a week September to June.

2. Upon completion of the selection process of eligible children, an appointment will be made with

individual families by an Intake Team member to complete an enrollment intake with the family. An

interpreter will complete intakes for non-English speaking families.

3. The parent is asked to bring to the enrollment intake appointment their child’s immunization record,

birth certificate, and proof of insurance information. They are also asked to make an appointment for

their child’s physical and dental exam and provide those dates at the time of their enrollment intake.

If they do not have insurance or a physician/dentist, the Intake Team member will provide a list of

providers.

4. An intake packet will be completed with a member of intake team.

5. After the intake process is completed a child site file is generated on the child/family and is given to

the Family Advocate or Child Family Development Specialist of the classroom the child will be

attending. (See MSYS 7a Record Keeping Policy and Procedure MSYS 7a).

6. Prior to the beginning of class if possible, the family will receive a Welcome Visit by the Family

Advocate or Child Family Development Specialist. (See FS/PI 7a Welcome Visit Policy and

Procedure).

7. At the beginning of the program year a Parent/Child Orientation will be held to introduce the

child/family to the classroom, center, program services, and staff. During the program year, if a new

child/family enrolls the Family Advocate or Child Family Development Specialist will complete a

parent orientation. (See FS/PI 13a Parent/Child Orientation Policy and Procedure).

8. Once a child is accepted and an intake completed the child is considered enrolled in Head

Start/ECEAP. Those children accepted for the upcoming program year will be considered enrolled on

the first service day of class.

9. For families who are returning, the Family Advocate or Child Family Development Specialist will

review in the spring of the current year all pertinent information with the family (i.e. address, phone,

emergency contacts, and additions to the family unit, etc). Any changes will be documented on the

Change of Status form, signed by the parent and turned into the Program Coordinator.

10. After the start of the enrollment year, vacancies are filled as they occur from the waitlist. Families

are notified that they are on a waitlist in September / October.

11. Vacancies in both Head Start and ECEAP part-day sessions will not be filled when 30 days or less

remain in the programs enrollment year.

Enrollment of Families ERSEA 3e

Esta política cumple con la norma de rendimiento “Performance Standard 1305.7(a)(b)(c)” (C: 03/00; R: 02/16)


Inscripción de Familias

Política El Head Start/Early Childhood Education and Assistance Program (programa de educación y asistencia de

la primera infancia) servirá a niños que van a cumplir los 3 años de edad el 31 de agosto o antes. Noventa

por ciento de los niños servidos cumplirán con las pautas de elegibilidad del programa Head Start/ECEAP

sobre los ingresos. Entre los niños inscritos, un máximo de diez (10) por ciento por fuente de

financiación puede ser de familias que tengan más ingresos que el límite. Por lo menos diez (10) por

ciento de todos los niños inscritos en los programas de Head Start/ECEAP serán niños con una

discapacidad.

Procedimiento 1. Definiciones de Modelos del Programa

a. Clases Tradicionales (de día parcial) del Head Start—3.5 horas al día, 4 días a la semana

de septiembre hasta junio.

b. Clases Tradicionales (de día parcial) del ECEAP—3.5 horas al día, 3 o 4 días a la semana

de septiembre a junio.

c. Clases de Todo el Día (6 horas) del ECEAP, 5 días a la semana de septiembre a junio.

2. Después de ser finalizado el proceso de inscripción de los niños elegibles, uno de los miembros

del equipo de inscripciones (Intake Team) programará una cita con cada familia para completar

una entrevista de inscripción con la familia. Un intérprete completará la entrevista de inscripción

para las familias que no hablen inglés.

3. A los padres se les pide llevar las siguientes cosas a la entrevista de inscripción: el registro de

vacunas de su hijo, su acta de nacimiento y su información de cupón médico o una prueba de

seguros médicos. También se les pide que programen una cita para un examen dental y un

examen físico y que provean esas fechas a la hora de su entrevista de inscripción. Si no tienen

seguros médicos o si no tienen doctor o dentista, el miembro del equipo de inscripciones le dará

una lista de proveedores de esos servicios.

4. Un paquete de inscripción será completado con un miembro del equipo de inscripciones.

5. Después de completar el proceso de inscripción, un expediente del niño/familia será generado y

será entregado a la trabajadora social de la clase a que asistirá el niño. (Ver MSYS 7a--Record

Keeping Policy and Procedure).

6. Antes del comienzo de clases, si es posible, la familia recibirá una visita de bienvenida de la

trabajadora social. (Ver FS/PI 7a Welcome Visit Policy and Procedure).

7. Al comienzo del año programático, se realizará una reunión de Orientación de Padres y Niños

para que el niño y la familia conozcan el salón, el centro, los servicios del programa y al personal.

Durante el año programático, si un nuevo niño o familia se inscribe en el programa, la trabajadora

social completará una orientación de padres con la familia. (Ver FS/PI 13a Parent/Child

Orientation Policy and Procedure).

8. Una vez que un niño sea aceptado y una entrevista de inscripción sea completada, el niño será

considerado inscrito en el Head Start/ECEAP. Los niños inscritos en el siguiente año

programático serán considerados inscritos el primer día de clases.

9. Para las familias que regresen, la trabajadora social revisará con la familia toda la información

relevante (o sea, el domicilio, el teléfono, los contactos de emergencia, los miembros adicionales

de la familia, etc.) en la primavera del año actual. Los cambios serán documentados en el

formulario “Change of Status” (cambio de situación), que será firmado por el padre o la madre y

será entregado al Coordinador del Programa.

10. Después de comenzar el año programático, cuando ocurran vacantes éstas serán cubiertas con

niños que estén en la lista de espera. En septiembre u octubre las familias serán notificadas que

están en la lista de espera.

11. Cuando 60 días o menos quedan del año programático, no se cubrirán las vacantes de las clases

de día parcial en el Head Start/ECEAP.

ERSEA 4a1


LOWER COLUMBIA COLLEGE EARLY HEAD START

Intake/Enrollment Appointment

Child: Birthdate:

Parent/Guardian:

Phone: Other Phone:

Intake Date: Time: First Home Visit Date: Time:

Reminder(s)

EHS Staff Member: LOC ID:

Enrollment Date:

When calling to schedule Intake Appointment/Home Visit, discuss the items below with parent.

Shot Records

Medical Coupon/Insurance Card

Birth Certificate

Physician/Clinic

Appt:

Dentist

Appt:

WIC

Specialist

Progress Center

==========================================================================

INTAKE FORMS CHECKLIST

Date Completed/Reviewed:

_______ ChildPlus Contact Information #1520 _______ Health History/Nutrition Intake

_______ Parent Agreement Contract _______ PIR Health & Child Care

Releases: Questionnaire

_______ Medical _______ WA State Immunization Form

_______ Dental (with parent signature and date 2 times)

_______ Birth Hospital (for infants only i.e. PeaceHealth/ _______ Caries Risk Assessment

St. John and Legacy Salmon Creek Medical Centers) _______ Case Management (Intake Event

_______ Specialists Entry on ChildPlus, Family Services)

_______ Mental Health _______ USDA Enrollment

_______ Progress Center _______ Formula Offer Form (Infant)

_______ WIC _______ Diaper/Pull-Up Offer Form

_______ OHSU _______ Review Application

_______ Other ____________________

Prior to child being at a program center: A completed Washington State Immunization form, a

completed USDA Enrollment form and Formula Offer Form (infants only) must be on file. A child,

attending a center-based model, must also have a completed Health History/Nutrition Intake form and a

completed Parent Agreement Contract on file.

ERSEA 4a2


LOWER COLUMBIA COLLEGE EARLY HEAD START – PRENATAL

Intake/Enrollment Appointment

Expectant Mother: Birthdate:

Due Date of Baby: ____________________________________

Phone: Other Phone:

Home Visit Date: Time:

Reminder(s)

EHS Staff Member: LOC ID:

When calling to schedule Intake Appointment/Home Visit, discuss the items below with expectant mother.

Medical Coupon / Insurance Card

Physician / Clinic

Appt:

Dentist

Appt:

WIC

==========================================================================


Date Completed/Reviewed:

_______ ChildPlus Contact Information #1520

_______ Prenatal Emergency Information Form

_______ WIC Release

_______ First Steps Release

_______ Review Application

_______ Releases (Optional)

_______ Medical

_______ Dental

_______ Mental Health

_______ Other ____________________

_______ Prenatal Health/Dental/Nutrition

History

_______ Prenatal Dental History Questionnaire

_______ Case Management (Intake Event Entry

on ChildPlus, Family Services)

_______ Parent Agreement Contract

ERSEA 4a



INTAKE APPOINTMENT

Child: Birthdate:

Does the child need an interpreter? (circle one) Yes No If yes, what language?

Parent/Guardian:

Phone: Other Phone:

Appointment Date: Time:

Reminder(s)

Teacher: LOC ID:

When calling to remind of appointment, remind parent of items they

are to bring including appointment dates if they’ve already made them.

Parent to bring in:

□ Shot Records □ Insurance Card □ Birth Certificate

□ Physician / Clinic

Appt:

Dentist:

Appt:

WIC

Specialist

=====================================================================


□ ChildPlus Contact Information #1520

□ Birth Certificate

□ Application Information/Income

Verification/Criteria Score Sheet

□ Releases

□ Medical

□ Dental

□ Specialists

□ Mental health

□ WIC

□ OHSU

□ School Districts

□ Other ______________________

□ HOFL Registration Form

□ PIR Enrollment Questionnaire

□ Immunization Form (with parent

signature)

□ Health History/Nutrition Intake

□ Caries Risk Assessment

□ Intake Event Entry on ChildPlus,

Family Services

□ Review Application

□ Sex Offender verification of parents/

emergency contact

HANDOUTS:

□ Bright Futures “3 or 4 yr. visit”

□ Dental Do’s/Health Exam Do’s

□ Healthy Eating/Active Play

□ Lead Screening

Signature

Date

ERSEA 5a

(C: 03/00, R: 02/12)


Recruitment Plan

Policy

In order to reach those most in need of Lower Columbia College Head Start (HS) / Early Head

Start (EHS) / Early Childhood Education Assistance Program (ECEAP) availability of services

the recruitment process will be followed to actively inform and encourage all income eligible

families, pregnant women and children with disabilities regardless of sex, race, creed, color or

national origin to apply for admission to the program.

Procedure

A Recruitment/Selection committee will be established in October of each year comprised of

parents, staff and leadership. The main goal of this committee is to identify families whose

children are age eligible for Head Start/EHS/ECEAP, meet the income guidelines and the

recruitment efforts throughout the county. In order to serve the families with the greatest need

the following recruitment process takes place.

1. Obtain current information for returning Head Start / EHS/ ECEAP students by the end of

the program year.

2. Update the existing waitlist showing only age eligible children.

3. Parents and staff will talk with local agencies, service organizations, PTA/PTO

organizations, and elementary teachers to promote Head Start/ EHS / ECEAP in the

community.

4. Local radio stations will air spots for public service announcements that run several times

a day through out the recruitment period.

5. The local newspaper will be contacted year round for possible feature stories about Head

Start / EHS / ECEAP focusing on recruitment.

6. The Lower Columbia College reader board will be utilized to promote enrollment.

7. On the campus of Lower Columbia College, the registration office, student center, ESL

and ABE classes and campus bulletin boards are provided with flyers and asked to refer

students/families.

8. The Community Partnership/Public Relations Specialist heads up public relations events

throughout the year. For example: Earth Day, Safe Kids Day, the Hispanic Health Fair,

Holiday Parade, Prevention Fair, National Night Out, Go 4th

Parade and the International

Festival are possible recruitment events during the year.

9. The Direct Service Teams will provide current parents with applications in the spring for

any age eligible siblings listed on our database.

ERSEA 5a

(C: 03/00, R: 02/12)

10. Each parent will be provided with recruitment flyers to give to a friend or neighbor that

has an eligible child.

11. Address lists of low-income families in the Cowlitz County service area provided by

DSHS are utilized for recruitment mailings.

12. Rally Day Events:

Head Start/EHS/ECEAP brochures, flyers and posters are delivered to agencies,

churches, dental offices, medical offices, child care providers and schools. All area

elementary schools are also asked to distribute recruitment flyers to kindergarten, first

and second grades. All of these agencies will be asked to refer eligible families to our

program.

Committee members will canvas the county to distribute flyers to local businesses,

grocery stores, Laundromats, bread stores, resale outlets, thrift centers, trailer parks,

swimming pools, park and recreation facilities, school carnivals, area fairs, Special

Olympics and businesses with sizeable employee numbers.

Door to door campaigns in low economic areas will be done by parents and staff.

Interpreters will contact and provide flyers and applications to businesses that provide

ethnic foods and services, churches providing non-English speaking services and

other agencies providing assistance to non-English speaking families

Policy complies with Performance Standard 1305.5

Quality Preschool and Family Support Program for Prenatal to Age Five


Head Start, Early Head Start, ECEAP

360.442.2800

360.442.2800

Head Start, Early Head Start (EHS) and Early Childhood Educa-tion Assistance Program (ECEAP) assist low income families in raising healthy children, in preparing children for future academic success, and in identifying pathways for family mobility.

WHO QUALIFIES FOR THE PROGRAM?

We serve families in Cowlitz County whose income is at or below the Federal/State Poverty Guidelines. Children with special needs, foster children, homeless families or families who are at risk, are encouraged to apply. Applications are accepted throughout the year.

HEAD START/ECEAPFree Preschool Services for 3-5 year olds

• Children must be age 3 by September 1st• Classes run from September – June• Class options include: 3.5 hours a day, 3-4 days a week or 6

hour days, 5 days a week

EARLY HEAD START• Free year round home visiting services - prenatal to age three• Services and support for Teen Parents• Monthly Play Groups for parents and children

We o�er 8 di�erent locations in Cowlitz County to serve your family. We have classes in Longview, Kelso, and Castle Rock. Limited transportation is available.

MAIN OFFICE1720 20th Ave Longview, WA 98632

Call 360-442-2800 – Fax 360-442-2819 Apply Online at:

https://lowercolumbia.edu/head-start/Facebook

https://www.facebook.com/LCCHeadStart/

Programa GRATIS de preescolar de calidad y apoyo para familias

Prenatal a los cinco años de edad


Head Start, Early Head Start, ECEAP

360.442.2800

360.442.2800

Los programas Head Start, Early Head Start y ECEAP ayudan a familias de bajos ingresos a criar a niños sanos, preparar a niños para tener éxito en el futuro e identi�car cómo familias puedan avanzar.

¿Quiénes son elegibles para el programa?Servimos a familias que tienen ingresos al nivel federal/estatal de pobreza o menos. Les animamos a que soliciten el programa familias de cuidado temporal, familias que tengan niños con necesidades especiales, familias sin hogar y familias que estén a riesgo. Se aceptan solicitudes durante todo el año.

HEAD START/ECEAPServicios de preescolar gratis para niños de 3-5 años de edad

•Los niños tienen que cumplir los tres años de edad antes del 1° de septiembre• Las clases son de septiembre a junio• Opciones de clases incluyen: 3.5 horas al día, 3-4 días a la

semana o 6 horas al día, 5 días a la semana

EARLY HEAD START• Servicios gratuitos de visitas al hogar durante todo el año -prenatal a los tres años de edad

• Servicios y apoyo para madres y padres adolescentes• Grupos de jugar para padres de familia y niños cada mes

Para servir a su familia, tenemos 8 sitios diferentes en Cowlitz County. Tenemos clases en Longview, Kelso y Castle Rock. Tenemos transporte limitado.

Dirección de la o�cina principal 1720 20th Ave Longview, WA 98632

Teléfono 360-442-2800 – Fax 360-442-2819Solicite en línea: https://lowercolumbia.edu/head-start/

Facebookhttps://www.facebook.com/LCCHeadStart/

HeadStart.Spanish.pdf 1 2/16/2018 1:21:18 PM

Free preschool for children 3-5 years old and services for pregnant women and children 0-3 years of age.

Serving children and families in Longview, Kelso, Castle Rock, Toutle and Kalama.

Now Enrolling!

Call 360-442-2800 or apply online at:

https://lowercolumbia.edu/head-start/



Now Enrolling!





Now Enrolling!





Now Enrolling!



Prescolar gratis para niños de 3-5 ded edad y servicios para mujeres embarazadas y niños de 0-3 años de edad.

Ayudamos a niños y familias de Longview, Kelso, Castle Rock, Toutle y Kalama.

¡Estamos aceptando a niños ahora!

Llame al 360-442-2800 o solicite en línea:

















ERSEA 5e

(C: 02/18)

Lower Columbia College Head Start/EHS/ECEAP Procedure and Guide for Logo Use in Marketing Materials and Correspondence

Procedure

LCC Head Start/EHS/ECEAP received LCC Cabinet approval January 2018 to implement a logo created by On The Mark Associates for branding and marketing purposes. The logo was brought to Policy Council for review and approval on January 22, 2018. The LCC Head Start/EHS/ECEAP logo (a brown branch and green leaves inside a red and blue heart) represents the diverse families, relationships and growth that occur among families, staff, and the positive impact our program has in our community. The Lower Columbia College name, font, and color meet the guidelines set forth in the Lower Columbia College Brand and Style Guide (see https://lcc.ctc.edu/info/webresources/Institutional-Research/LCC_Brand_Style_Guide.pdf). The logo created by On The Mark Associates is not to be altered in any way and should be used in all marketing materials. You can access the logo and its variations by visiting our Head Start webpage, under Reports and Handbooks, it is found in ERSEA 5e.

Minimum Size for Reproduction

If the logo is too small, the intended audience may not clearly recognize it as part of our brand. To maximize readability and clarity of our logo, the minimum size for reproduction is 1” in width (for reference, that’s the size used on LCC business cards). Clear Space

To ensure proper readability, provide visual impact and protect brand identity, the LCC Head Start/EHS/ECEAP logo should always have space around it (generally referred to as “clear space.”) This space should be free of other graphic elements such as photos, artwork, etc. Logos Do’s and Don’ts

Do display the logo and other branding elements correctly. Do request assistance from Administrative Services Manager or Public Relations Specialist if you have questions or have a special project or need. Do not alter the logo and other branding elements in any way. This includes the shape, proportion of elements, and/or typeface. Do not alter the color of the logo, or add special effects. The logo and other branding elements should not appear in any color other than those provided.

https://lcc.ctc.edu/info/webresources/Institutional-Research/LCC_Brand_Style_Guide.pdf

ERSEA 5e

(C: 02/18)

Email and Email Signatures

Email signatures (used at the bottom of email correspondence) constitute an important aspect of brand identity. As with other aspects of communication, consistent application of branding guidelines helps to bolster our reputation and subsequently support enrollment. Do not use backgrounds in email under any circumstances. Email signatures should contain your name, title, and contact information. Graphic elements are optional. If you choose to use graphic elements, you should use only the graphic elements included in this guide as part of your email signature. To set up an email signature in Outlook, select “new email.” In the new email window, select “signatures.” From the “signatures and stationery” window, you can create, rename, edit or delete email signatures. From the same window, you can also select which signature you would like to use (if you have more than one) on any given email you send. Early Childhood Education Assistance Program (ECEAP) Logo

LCC Head Start/EHS/ECEAP will use the Department of Early Learning (DEL) ECEAP logo on all marketing materials, recruitment flyers and annual reports. The full-color or black-and-white DEL or DEL ECEAP logo must appear in its entirety without modification (see 2017-2018 ECEAP Client Service Contract p. 7).

Office of Head Start – National Head Start Logo

LCC Head Start/EHS/ECEAP will use the Office of Head Start – National Head Start logo in its entirety, without modification, in all marketing materials.

United Way Logo

LCC Head Start/EHS/ECEAP will use the United Way Logo on agency communications, such as newsletters, reports, signs, etc. Additionally, the Leadership team will use the United Way Logo in the signature line of their email.

References

LCC Brand and Style Guide https://lcc.ctc.edu/info/webresources/Institutional-Research/LCC_Brand_Style_Guide.pdf

https://lcc.ctc.edu/info/webresources/Institutional-Research/LCC_Brand_Style_Guide.pdf

ERSEA 5f

(C: 02/18)

Lower Columbia College Head Start/EHS/ECEAP Logos for use in Marketing Materials and Correspondence

The LCC Head Start/EHS/ECEAP logo was created by On the Mark Associates and approved by LCC Cabinet and Policy Council January 2018. The logos are not to be altered in any way and should be used in all marketing materials and correspondence*.

Head Start Small Logo

Black and White Logo

Head Start jpg.

Head Start Shadow Logo

*See ERSEA 5d “Procedure and Guide for Logo use in Marketing Materials and Correspondence” for further instruction.

ERSEA 6a

(R: 07/10; C: 07/03)

Lower Columbia College Head Start / EHS / ECEAP

Community Assessment

Policy Every three years Lower Columbia College Head Start/EHS/ECEAP will conduct a community

assessment to collect data about community strengths, needs and resources. This data will be

used to make decisions about the type of services provided for children and families and to

determine collaboration possibilities with other agencies.

Approved by Policy Council on July 10, 2003

Procedure

1. Every three years Head Start/EHS/ECEAP will conduct a Community Assessment within

its service area of Cowlitz County.

2. The Community Assessment at a minimum will include the collection and analysis of the

following information on eligible children and families:

a) The demographic make-up including the number of eligible children/families,

geographic location and racial ethnic composition.

b) Information on other child development and child care programs within in the

service area that are serving HS/EHS/ECEAP eligible children.

c) The estimated number of children with disabilities four (4) years old or younger,

including the type of disability and relevant services and resources provided these

children by community agencies.

d) All current data regarding education, health, nutrition and social service needs of

eligible children and their families.

e) The education, health, nutrition and social service needs as defined by families of

Head Start/EHS/ECEAP children and by institutions that serve young children.

f) The resources within the community that could be used to address the needs,

which includes the assessment of their availability and accessibility.

3. An analysis of the assessment information will be used to:

a) Determine the program philosophy, and its long and short-term goals and objectives.

b) Determine the type of component services that are most needed and the program

option(s) that will be implemented.

c) Determine the recruitment area to be served.

d) Determine appropriate locations for centers.

e) Set criteria that define the types of children and families who will be given

priority for recruitment / selection.

4. The annual grant planning and budget process will include a review and update of the

assessment information. An analysis of the updated information will determine if the

direction of services to eligible children and families need to be changed.

Policy complies with Head Start Performance Standards 1305.3(c)(d)(e)

Documents

1. Application - Lower Columbia College Homepagelcc.ctc.edu/info/...Recruitment-Selection-Enrollment-Attendance.pdf(Revised 03/18) Lower Columbia College Head Start/EHS/ECEAP Eligibility,