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Program Forms
Big Sandy Area Community Action Programs
Head Start Forms
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- Confidential Reporting Form: Suspected Child Abuse
- Confidential Reporting Form: Suspected Child Abuse by Staff Member
- Directions for Submitting Career Development Requests
Requests for College Course Work
- Career Development Checklist
- Career Development Request Form
- Career Development Tuition Reimbursement Agreement
- Release of Information
- CDA Tuition Reimbursement Agreement
- Class Attendance Mileage Reimbursement - Staff Only; See Parent Reimbursement Forms Below
Reporting Child Abuse
Career Development ~ Staff
- Developmental Screening Results Form
- RTI -Child Information Form
- RTI-Child Information Form (Excel Version)
- 30 Day New Staff Survey
- Bus Evacuation Drill
- Child Arrival-Depature 4 Day Week
- Child Arrival-Departure 5 Day Week
- CLASS Concept Development Questions
- Classroom Display Requirements
- Documentation of Flame Retardant Treatment
- Field Trip Form (2020-2021)
- Fire Drill Form (2020-2021)
- Head Start Conference Form
- New Staff Orientation Checklist
- Parent Curriculum Input Form
- Playground/Gross Motor Area Safety Checklist
- School Readiness Goals for Parents - 1st Education Home Visit
- Tornando and Earthquake Drill Form (2020-2021)
- TSG Alphabet, Shapes, and Numbers Form
- Volunteer Suggestions
- Change of Status
- Eligibility Points 2020-2021
- Eligibility Verification Form 2020-2021
- Family Residency Questionaire
- Record Relocation Check Sheet
- Release of Student Information
- Zero Income Form
- Classroom Volunteer Declaration of Child Abuse
- Community Partnership Form
- Family Assessment Form
- Family Home Projects
- Family Interest Survey
- Family Partnership Agreement
- Family Visit Form
- General Guidelines for Defining Status Levels
- Parent Board Monitoring Form
- Parent Board ~ Disability Guide
- Parent Board ~ Parent Literacy & Career Development Flyer
- Parent Board ~ Website Information
- Parent Training Plan
- PFCE Family Needs Assessment Form
- Staffing Instructions
- Allergy Questionaire
- Asthma Questionaire
- Asthma Plan
- Authorization for Medical Dental Services
- Child Referral Letter
- Classroom Emergency Plan for Injury
- Consent for Follow-up
- Daily Health Check Documentation Sheet
- Dental List
- Dental Travel Permission
- Emergency Medical/Dental Treatment Consent 2020-2021
- First Aid Inventory Checklist
- Head Injury Letter
- Health and Safety Checklist
- Head Start Health Requirements List for Parents
- Hemoglobin Screening Permission
- HIPPA Release of Information-Floyd County
- HIPPA Release of Information-Johnson County
- HIPPA Release of Information-Magoffin County
- HIPPA Release of Information-Martin County
- HIPPA Release of Information-Model City
- HIPPA Release of Information-Paintsville City
- HIPPA Release of Information-Pike County
- Immunization Letter for Model City Only
- Immunization 1st Reminder Letter
- Immunization 2nd Reminder Letter
- Incident Report Form
- KY Immunization Exemption
- KY Dental Form
- KY Physical Form
- KY Vision Form
- Lice Notice to Parents
- Medical Screening Permission (Nurse)
- Medical Screening Results
- Medication Administration Daily Log
- Parent Letter for Needed Health Information
- Parent Refusal Documentation
- Permission Form for Prescribed or Over-the Counter Medication
- Preventative Health Questionaire
- Provider Statement
- Screening Results
- Seizure Health Care Plan 2020-2021
- Summer Screening Permission
- Teacher's Observation Child's Health
- Toothbrushing Chart
- Verification of Child Health
- Verification of Dental Examination
- Vision Travel Form
- Weekly Diapering/Pull-Up Changing Log
- Family Home Projects
- Volunteer Health Assessment
- Volunteer In-Kind Sheet
- In-Kind Key Guide
- Volunteer Sign Up Sheet ~ Monthly Activities
- Monthly In-Kind Hours
- Acknowledgement of Privacy Practices
- Authorization for Release of Health Information
- Consent Form
- Refusal for Consent to Mental Health Services
- Master Roster
- Meal Count Sheet
- Snack Menu Form
Family Services
- Family Support Services for Nutrition
- Family Support Servies for Nutrition Instructions
Food Modifications
- Food Allergy Plan
- School Food Service Modification Form ~ Floyd, Johnson, Magoffin. Martin, Paintsville, Pike
- Permission to Post
Growth Assessment Follow-up
- Notification of Growth Asssessment Form
- Over Weight Tips
- Under Weight Tips
- Election of Officers Minutes
- Parent Committee Cancellation
- Parent Meeting Agenda
- Parent Meeting Minutes
- Parent Meeting Sign-In
- Directions for Literacy & Career Development Assistance for Parents
- Career Development Request Form
- GED/Literacy Effort Request Form
Disabilities
Education/Classroom
ERSEA
Family Services
Health
In-Kind/Volunteer Services
Mental Health
Nutrition
CACFP
Parent Committee
Parent Literacy & Career Development
Parent Reimbursement
Policy Committee
