Head Start Program Forms

Case Management Form


Early Head Start & Head Start Program Forms and Informational Handouts

 LaserFiche Forms


  • NAME, ADDRESS, PHONE or EMAIL ADDRESS (changes to the HS participant or primary adult name, address, phone number, or email address)
  • NON-Foster Change of Custody (changes in the HS participants custody situation, not to include foster care changes)
  • HOUSEHOLD MEMBERS (changes in household member(s) moving in or out of the house)
  • FOSTER CARE (changes in the HS participant foster care situation)
  • ACCESS TO CHILD (changes to the emergency card or OFP information)
  • OTHER Information
    (changes to HS participant medical insurance, medical/dental home, family benefits (WIC, TANF, food stamps), or current adult employment, school, or education status )

Income Verification Form

Request for Records - This form will be used by all staff to submit a request to the Head Start office to process a "Request for Participant's Records".

Staff - Submit An Individual Training Completed Form:   Formerly titled "External Training Tracker".  Use this form to submit training information for a training you have completed individually outside of trainings planned, organized, and held by Head Start.

Office - Submit a Planned Head Start Training:   For OFFICE USE ONLY.   Use this form to submit a training being planned and organized by the office for staff to participate in.

FILLABLE FORMS - Can be downloaded, completed, saved and emailed if required

Case Management

Child Abuse and Neglect Report Form  -  ST. LOUIS COUNTY Report Child Abuse Link

Child and Adult Care Food Program (CACFP) Forms:

Disabilities & Mental Health Related Forms:

Disposition of Medication

EHS Transition Form

Employee Hepatitis B Vaccination Form (Blood Borne Exposure Form)

External Training Tracker  (MS Excel Document)

Field Trip and Event

Getting to Know Your Child and Family

Lesson Plan - Distance Learning (MS Word Document)

Lesson Plan Preschool (MS Word Document)

Lesson Plan - Media Use Template

Lesson Plan - Small Group Activity Template

Material Requisition Request Form    -     Click here for the Head Start:  Inventory Catalog

MARRS (MN Early Childhood Registration Form)

Staff Emergency Information

Staff In Service Training Record (DHS-4679-ENG)

Sunscreen Permission

PRINTABLE FORMS - Download and print.  These forms CAN NOT be filled out electronically.

Behavior Incident Report (BIR) Form  -  Behavior Incident Report (BIR) Directions

Bloodborne Exposure Medical Exam Declination for Staff (Blood Borne Exposure Form)

Bus Attendance and Tracking (MS Excel Document)

Child and Adult Care Food Program (CACFP) Enrollment Form

Child and Family Signature Tracking

Children's Dental Service (CDS) Consent Form

Daily Sign In/Out Form

Employee Health Exam Form

Immunization Exemption Form (MN Dept. of Health)

In Kind - At Home Activity Sheets:

Minneapolis Preschool Screening Instrument (For RESCREEN ONLY)

Pathway 2 Scholarship Application

Paid Time Off (PTO) Pay Out

Post Exposure Medical Evaluation (Blood Borne Exposure Form)

Separation Report

Sign In/Out - Non Parents Form


Informational Handouts

Health Alert Notices:


AEOA Departments

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