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Home My WebLink About850936.tiff Weld County, Colorado MIGRANT HEAD START/CHILD CARE Submitted to: Mr. Robert Foster, Acting Chief Migrant Programs Branch ACYF - Head Start Bureau 400 6th Street, S.W. Washington, D.C. 20201 Submitted by: Walter J. Speckman, Executive Director Weld County Division of Human Resources P.O. Box 1805 Greeely, CO 80632 Telephone: (303) 353-0540 f.. TABLE OF CONTENTS Page PART I BASIC INFORMATION 1 PART II PROJECT APPROVAL INFORMATION 2 PART III BUDGET INFORMATION 3 PART IV PROGRAM NARRATIVE 5 1. Objectives and Need 5 2. Results or Benefits Expected 8 3. Approach 8 4. Geographic Location 32 PART V ASSURANCES 33 k OMB Approval No.0348-0006 FEDERAL ASSISTANCE 2.CANT'S a_NUMBER 3. NUMBER APPLI- . APPLI- CATION I. TYPE CATION IDENfTI- OF 0 NOTICE OF INTENT(OPTIONAL) IDENT1- b.DATE FIER v b. DATE SUBMISSION �-1 FlER Year month day ti�$_HD ASSIGNED Yom, ;none; dy;- (fAark ap- 0 PREAPP'J ATICN propriate E4 APPLICJ1TlON 19 85 06 03 BY STATE 19 box) ---------- Blank 4. LEGAL APPLICANT/RECIP1D4T 5. EMPLOYER IDENTIFICATION NUMS- R(EIN) a.Applicant Noma . Weld County Division of Human Resources b.Organization Unit - Head Start Program 6. c.Street/P.O. Box . P. 0. Box 1805 PRO. a. NUMBER I1 131 • 16 I 01 0E d.City . Greeley ,.Counly Weld GRAM f.State . Colorado y.ZIP code. 80632 (From CFDA) MULTIPLE ❑ h.Contact Parson(Name Walter J. Speckman, Executive Director b. TITLE "1i Brant Head Start/ a TelephoneNa.l - (303' 353-0540 __ 7. TITLE OF APPLICANTS PRO. CT(Use sec bon IV of this form to provide a summary description of the 8. TYPE OF APPLICANT/RECIPIENT o project) ° ' d :,e H--rs°.d'..�.rAy"caxr . C StA.�ias F tQ/-.r FA rY Y it Beak, • 1985 - Weld County Migrant Head Start/Day Care Program 6. CE W F Dot Enter aysroyr+atr letterI rbi 9. AREA OF PROJECT IMPACT f nee of cities.COtiaiex states,etc) 10.ESTIMATED NUMBER 11. TYPE OF ASSISTANCE 3 Weld and Adams County OF PERSONS BENEFITING E 200 c Er. 12. PROPOSED FRINGING 113. CONGRESSIONAL DISTRICTS OF: 14. TYPE OF APPLICATION '.--tree F-Rarcion c -1 308 899 a. APPLICANT — b. PROJECT a-�-,-. o- ,� fn I a.FEDERAL S a 00 Enrer old,rrwtr Irc: 4G i b.APPLICANT 61,779 .00 4 County-Wide '17.TYPE OF CHANGE.(For/ae e,Me) A-6-cream°came F—OGxr t c/f'/. .00 15. PROJECT START 16. PROJECT s— A a DoN°$ C.STATEDATE DURATION --o-v $cuaae D 'O' d.LOCAL 00 Year month day E�c�e anon 19 85 06 17 5 Morsths, a.OTHER 29, 500-0 1 f„ta.r , + 18. DATE DUE TO Year month day Plots r?aa-(s) L I 1. Total $ 400,178 -°°I FEDERALAGENCYs 19 R5 n5 03 --- 19. FEDERAL AGENCY TO RECEIVE REQUEST Administration for Children Youth and Families 2(1 EXISTING FEDERAL GRANT IDENTIFICATION NUMZER a. ORGANIZATIONAL UNIT(IF APPROPRIATE) rb.ADMINISTRATNE CONTACT(IF KNOWN) j c. ADDRESS T21. REMARKS ADDED I 22. To the best of my l=alsdge and belief, a- YES,THIS NOTICE OF INTENT/PREAPPLICJ.TIGW/APPLICATION VIAS MADE AVAILABLE TO THE STATE THE data In this proapPica,ioi/application EXECUTIVE ORDER 12372 PROCESS FOR REVIEW ON: 6 APPLICANT ars true and correct ne document has E CERTIFIES been eilitY author290 the 9ovett"n9 DATE T'HATD- body of the sppiasara and the applicant cc cc will comply with the a shed assurances b. NO,PROGRAM IS NOT COVERED BY EO. 12372 0 —` -- if the ass 'e is approved. OR PROGRAM HAS NOT BEEN SELECTED BY STATE FOR REVIEW O 6 23. a. TYPED NAME AND TITLE {b- SIGNATURE ' CERTIFYING Jacqueline Johnson, Chairman 1 w REPRE- rn SENTATIVE Board of Commissioners 24. APPLICA- Year month day 25. FEDERAL APPLICATION IDE ON N '` ^R 26. FE r R. L GRANT IDENTIFICATION TION RECEIVED 19 27. ACTION TAKEN 28. FUNDING Year month day STARTING Year month rh r?nse < 0 a. AWARDED 29. ACTION DATE'. 19 DATE 19 o Q b. REJECTED a. FEDERAL —S .00 31. CONTACT FOR ADDITIONAL INFORM-- 13yDING Year month date C° ❑ c. RETURNED FOR _ -- TION!.Fame and telephone number) ENDI 18 1- < AMENDMENT b. APPLICANT .00 o 0 d RETURNED FCR —— 00 33. REMARKS ADDED 6 6 E.O. 12372 SUBMISSION c. STATE iz o BY APPLICANT TO d. LOCAL .00 N STATE ❑e. DEFERRED ,a_ OTHER .00 0 f. WITHDRAWN f- TOTAL S .00 .1 Yo; I No NSN 7540-01-008-8162 424-103 _STANDARD FORM 424 PAGE 1 (Rev.4-84 PREVIOUS EDITION Prescribed by OMPB C,, !ar 4-102 IS Nt1T USABLE 1 PART 11 OMB NO.°3ze.oco PROJECT APPROVAL INFORMATION Item 1. Does this assistance request require Name of Governing Body State,local regional,or other priority rating? Priority Rating Yes No Item 2. Does this assistance request require State, or local Name of Agency or advisory, educational or health clearances? Board Yes No (Attach Documentation) Item 3. n ,/ Does this assistance request require State, local, Name of Approv g Agency x C b\S-i\2 5 1_�e;<-*J a regional or other planning approval? Date Yes No Item 4. Is the proposed project covered by an approved comers- Check one: State ❑ hensive plan? Local O Begone' • Yes No Location of Pla ❑ Item 5. Will the assistance requested serve a Federal Name of Federal Installation installation? Yes No Federal Popaticn benefiting from Project Item 6. Will the assistance requested be on Federal land or Name of Federal Installation installation? Location of Federal Land .._Yes No Percent of Project • k Item 7. ill the assistance requested have an impact or effect See instruct uns :or additional information to be on the environment provided. Yes No Item 8. Number of: Will the assistance requested cause the displacement Individuals of individuals,families,businesses,or farms? Fa:^miiies _ Businesses Yes No Farms Item 9.Is there other related assistance on this project previous, See instructions tor additional information to be pending,or anticipated provided. Yes No 2 } ovallo. PART HI - BUDGET INFORMATION SECTION A-BUDGET SUMMARY Grant Program, Funds Estimated Unobligated New or Revised Budget Function or Activity Catalog No. Federal Non-Federal Federal Non-Federal Total (a) (b) (c) (d) (e) (t? (9Z 1. PA 23 $ $ $ 281.922 $ 56,384 _$ 338¢346 _ ,2. PA 26 . 26,977 5,395 32,322 3. 4. 5. TOTALS $ $ $ 308.899 $ 61,779 i$ 370 .� SECTION B-BUDGET CATEGORIES 6. Object Class Categories -Grant Program, Function or Activity Total I (i) PA 23 (2) PA 26 (3JIUTR/USDA J4) (5) a. Personnel '$ 189,577 $ 12,470 S (12,320) $ $ 202,047 b. Fringe Benefits i 31,405 1,621 (1 ,602) 33,026 c. Travel 2,600 (-0-) 2,600 K d. Equipment 2,886 (-0-) 2,886 e. Supplies 13,000 (-0-) 13,000 f. Contractual 6,140 10,000 (-0-) 16,140 g. Construction (-0-) _ -0- h. Other 39,200 (15,578) 39,200 i i I. Total Direct Charges j. Indirect Charges k. TOTALS $ 281,922 $ 26,977 _$ (29,500) $ $ 308,899 7. Program Income $ $ S $ $ ___J 3 ' c:-:No a ss-xoe SECTION C- NON-FEDERAL RESOURCES (a)Grant Program (b)APPLICANT (c)STATE (d)OTHER SOURCES (e)TOTALS 8. PA 23 $ 56,384 s $ _____.__ $ 56,384 9. PA 26 5,395 ___ L,395 A 10. 12. TOTALS -.. ._.. .... ._ $ 61 ,779 s $ .$ 61,779 SECTION D- FORECASTED CASH NEEDS Total for 1st Year 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter - 13. Federal $31)8,894 $ -0- $ 302,965. $ 205,933 $ ,0- 14. Non-Federal 61,779 -0- 20 coi 41,186 -0- 15. TOTAL $ 370,678 $ -0- .s123,559 Is 24,119 $ -0- -. — SECTION E- BUDGET ESTIMATES OF FEDERAL FUNDS NEEDED FOR BALANCE OF THE PROJECT 1_. FUTURE FUNDING PERIODS (YEARS) (a)Grant Program (b) FIRST (c)SECOND L (d)THIRD (e) FOURTH 16. PA ?3 $ 296.01a s 310.819 $ 326.360 $ 342,678 17. 28,326 29,742 31,2Z9____ 32,790 18. 19. --- 20. TOTALS $ 3?4.344 $ 340.561 $ 357,589 -- l$-.31_5,468 �- SECTION F- OTHER BUDGET INFORMATION (Attach Additional Sheets II Necessary) 21. Direct Charges: 22. Indirect Charges: 23. Remarks: PART IV PROGRAM NARRATIVE (Attach per instruction) 4 Part IV 1. Objectives and Need for Assistance: A. Relevant Community Problems: Weld County, Colorado, is primarily an agricultural county. In the past it has been ranked as #2 in the nation for crop production per acre. Weld County is a major part of the migrant stream and has relied on migrant and seasonal workers. The Weld County Division of Human Resources has traditionally served migrants as they come to Weld County by providing a variety of programs directed towards employment and training needs as well as supportive services such as child care, Supplemental Foods, referrals for health care, clothing, etc. In the past few years, the increased cost of child care, gas, food, and other living expenses has increased the hardship for migrant farm workers who traditionally migrate for work during the spring and summer seasons. Now, the agricultural business in Weld County, Colorado is facing a dramatic change. In Weld County, through the outreach completed by the staff and interaction with other service agencies which serve MSFWs, the following conditions have been identified: (1) In 1985, there will be a decrease in the types of crops planted in which MSFWs have traditionally been employed, therefore, there will be a decreased demand for MSFW services. Specifically, the farmers were unsuccessful in their attempt to purchase the sugar beet factories in the area. The unsuccessful bid meant an end to the sugar beet crop in northern Colorado for the 1985 agricultural season. (2) The lack of sugar beets has meant a decrease in the number of MSFWs coming into Weld/Adams County, Colorado for work during what has heretofore been considered the normal time period. The migrants are now expected to start arriving in northern Colorado in mid June, 1985 as opposed to April , 1985. This also means the migrants will be staying in the area through the majority of October. The farmers have opted to substitute the beet crops with beans, pickles, onions , carrots and potatoes. These crops have a different growing and harvest season. 5 Because of the uniqueness of the farmer's situation and the possibility that they may remedy the sugar beet factory situation for the 1986 season, the time frame involved is to be considered for the purposes of this grant as a special time frame. (3) More small farms are going out of business due to a decrease in the profit margin. (4) More mechanization of traditional seasonal labor crops. (5) Acreage is being planted in cash crops like beans and corn, which require no seasonal or migrant labor. B. Needs Assessment and Planning: The Weld County Head Start Program has participated in two (2) meetings with the community agencies who provide services to migrant farm workers in northern Colorado. The meetings took place in April and May, 1985, and were for planning purposes. The meetings are held on an annual basis. Throughout the summer months the agencies also come together to assess the resources available in the community and to identify and prioritize the services that still need to be provided to the migrant families coming into the area. The agencies participating in these meetings are : Colorado Rural Legal Services (CRLS) , Employment Opportunities Delivery System (EODS) , Plan de Salud del Valle Health Center, Weld Board of Cooperative Educational Services (BOCES) , Aims Community College, Division of Rehabilitation for Migrants, Rocky Mountain SER, Salvation Army, Department of Social Services Food Stamps, Sunrise Community Health Center, and the Weld County Health Department. The needs assessment which was a direct outgrowth of the planning meetings identified in order of importance the following needs: Child care Nutrition Health Care Employment Housing Supportive services i.e. , emergency food, transportation, etc. C. Confirmation of Change: Attachment 1 is a letter from the lccal Job Service Manager supporting the project and confirming the change in agricultural products for the 1985 season. 6 D. Primary and Secondary Objectives: The Weld County Head Start Program has established as its primary objectives for the Migrant Head Start Program: (1) To improve the child's health and physical abilities, including appropriate steps to correct present physical and mental problems. (2) To improve the families attitude toward future health care and physical abilities. (3) To encourage self-confidence, spontaneity, curiosity, and self discipline, which will assist in the development of the child's social and emotional health. (4) To enhance the child's mental processes and skills with particular attention to conceptual and communication skills. (5) To establish patterns and expectations of success for the child, which will create a climate of confidence for present and future learning efforts and overall development. (6) To increase the ability of the child and family to relate to each other and to others. t (7) To enhance the sense of dignity and self-worth within the child and their family. (8) To encourage parent and community participation in the development of opportunities in the educational and employment areas to help the children and their families to attain a higher quality way of life. The secondary objectives are: (1) To act as an advocate in behalf of migrant farm workers by networking with local agencies in the deliver of supportive services. (2) To establish an effective referral system to insure families receive the services needed and duplication of services is avoided. (3) Explore local , state, and federal resources to meet some of the needs identified and for which there are not resources available at the present (i .e. housing). (4) To work with the local media in educating the community as to the plight of migrant farm workers and their contribution to society, in order to gain their support and commitment. 7 The proposed project will be in compliance with the needs of the participants and the corrrwnity and will be consistent with ACYF performance standards. 2. Results Expected: Based on the number of migrants anticipated to move into the area, it is anticipated that 200 total children will be served. At the present time, plans are to serve 100 children in the Weld County center and 100 children in the Adams County/southern Weld County area. Naturally, this combination may require adjustments to be made (as it relates to the number of children to be served in each center). The participants in the program will be children of migrant farm workers as defined by the Indian and Migrant Program Division (IMPD). The needs assessment, which was explained in Section 1 of Part IV, was developed through a series of meetings held amongst the migrant service providers. Child care was identified as a rajor concern for the migrant families. This proposal will provide for the child care for migrant children ages 0 through 5 years of age. All children over the age of 5 will receive their child care services provided through Weld County BOCES. A continuity of services will be achieved. In the past, Weld County has entered into a purchase of service arrangement with the Colorado Migrant Council . The Colorado Migrant Council purchased from Weld County the services needed to operate the Migrant Head Start in Weld County. Since Weld County is attuned to delivering the services to migrants working in northern Weld County, this is an expansion of the effort as opposed to a brand new understanding. In order to answer the need for child care, Weld County is pro- posing to start the child care classes on July 1, 1985, and stop services on October 11 , 1985. 3. Approach: A. Plan of Action (1) Time Frame Action June 5, 1985 Start staff recruitment process June 17, 1985 Start recruitment of children June 24, 1985 Staff orientation (three days) June 27, 1985 Classroom set-up July 1, 1985 Classes/child care begins 8 October 11, 1985 Classes/child care ends October 18, 1985 Termination of all teaching staff October 25, 1985 Termination of all administrative staff (2) Budget Explanation Attachments 2 and 3 visually display the amounts needed to fund this proposal . It should be noted that significant dollar savings are being made due to the efficient and active coordination with the Weld County Welfare Diversion Program. The two programs working together will be advantageous for the Migrant Head Start Program in the areas of program and budget. The Welfare Diversion Program is run by the local Employment Opportunities Delivery System (EODS) which has combined the Job Training Partnership Act (JTPA) , Job Service of Colorado, and the Welfare Diversion Program into one service delivery system. The Weld County Division of Human Resources also administers the EODS programs. The Welfare Diversion Program services the single heads of households by offering them an alternative to the welfare system. This option has been exercised extensively by individuals currently receiving and/or applying for Aid to Families of Dependent Children (AFDC) in Weld County. The jobs that the heads of households are placed in enable them to develop job skills and a track record of acceptable work behavior, that will lead to their future employment in the private sector. The regular Weld County Head Start Program has an enroll- ment level of over 50% of the families are on AFDC or Welfare Diversion. Programmatically, the coordination with the Welfare Diversion Program has meant Head Start has been capable of staffing an additional teacher aide in each classroom. This has allowed staff to become more interactive with the family unit and plan/carry out additional lesson plans for the classroom. The additional teacher aide supplied by the Welfare Diversion Program has been trained by the Head Start Program and thus, a ready waiting list of qualified individuals to step into staff vacancies exists. Personnel wise, Head Start has eliminated the additional costs associated with training new staff and insured continuity of staffing services. In addition, the salaries are paid by the Welfare Diversion Program, resulting in further program savings. Budgetarily, the regular Head Start has benefited by coordinating with the Welfare Diversion Program. The 9 Head Start facility has undergone major renovation at extremely minimal costs because the JTPA Program has established a carpentry training course at the facility. Again, the coordination of the two programs enables eligible Head Start parents to be trained on-the-job in carpentry and Head Start reaps the benefits as well by having the facility renovated. Staffing has not been the only area where the efficiency of the Weld County Head Start Program is at its peak. The University of Northern Colorado has provided a significant contribution of professional services to the local Head Start and will hopefully continue to do so during the course of the Migrant Head Start Program. The university has structured special speech and hearing sessions for the program's special needs children. The children are receiving the most recent therapy and treatment techniques designed for their disability and the program saves money. (3) Program Design The Weld County Migrant Head Start/Day Care Program will operate the standard model . The Head Start Program will serve 15 to 20 children per classroom. The staffing pattern will be: one teacher and two teacher aides per classroom. The program is capable of having two teacher aides in each classroom due to the avid participation in the Welfare Diversion Program. One of the teacher aide's salary will be covered by the Welfare Diversion Program, which places personnel in all component areas of Head Start, providing considerable savings to the program. As visually demonstrated in Attachment 4, the children will be placed in two identified target areas. To reiterate, it is anticipated that 100 children will be placed in the Greeley center and 100 children will be placed in the southern Weld County/Adams County center. Transportation to and from both centers will be provided to the children through the Weld County Transportation Department. Utilizing the transportation service has proven to be very cost effective for the regular Head Start Program and the same result is expected for the Migrant Head Start Program. The change in the types of crops being planted in the area for 1985 will have an effect on the program. It is expected that the migrants will not arrive in the Weld and Adams County areas of Colorado until June 15, 1985. This is an approximate two month delay in their normal arrival . 10 Per the Weld County Job Service Center (which is considered a "significant office" for migrant purposes as defined by the Department of Labor) , approximately 1 ,200 to 1,300 migrants will arrive in the areas on or about June 15, 1985, to start work in the pickles. The individuals coming into the area for the pickles have established housing. The 400 to 500 additional migrants anticipated in mid to late July will work the onions and other harvests. These individuals will experience great difficulty in finding housing. This may influence the number of migrants who will stay in the area. The program proposes to provide direct child care services until October 11, 1985, in order to properly service the migrant families as they prepare to leave the area. (4) Innovations The coordination between the Weld County Head Start Program and the Weld County Employment and Training programs is exemplary. The same coordination efforts will take place during the course of the Migrant Head Start Program. It must be emphasized that the Weld County Migrant Head Start Program will strongly emphasize and demonstrate the willingness to bring together numerous community programs to insure that top notch quality programs and services are provided to the migrant child and family unit. These innovative coordination efforts will enable the Migrant Head Start Program to save money and yet increase the program's service level and quality. B. Information About the Proposed Program (1) Number of children to be enrolled: 200 (2) Number of handicapped children to be enrolled: Not less than 20 (3) Number of children for whom fees will be charged: 0 (4) Number of families above poverty income level : 0 Number of families below poverty income level : 100% (5) Number of hours per week of operation: 45 11 (6) Number of weeks per year of operation: Administratively - 19 Classroom/Child Care Services - 15 (7) Number of teachers: 12 (8) Number of paid teacher aides: 12 (9) Number of classes: 12 (10) Number of Infants: 60 Number of Infant Classrooms: 4 (11) Number of Toddlers: 60 Number of Toddler Classrooms: 4 (12) Number of Pre-Head Start: 40 Number of Pre-Head Start Classrooms:. 2 (13) Number of Head Start: 40 Number of Head Start Classrooms: 2 The infants and toddler rooms will have one teacher and 3 teacher aides. The extra teacher aides will be paid through the Welfare Diversion Program. Volunteers will also be recruited to work as teacher aides. The pre-Head Start and Head Start classrooms will operate with one teacher and 2 teacher aides. The following sections breakout the objectives for each component: 12 Education 1. Goal #1: To provide children with a learning environment and varied experiences which will help them develop socially, intellectually, physically and emotionally in a manner appropriate to their age and stage of development toward the overall goal of social competence. Objectives (to meet goal ) : a. The classroom is arranged into clearly defined learning activities which include the following learning centers: block area, dramatic play area, creative area, book area, music area, science area, manipulative area, and water play area. Each classroom provides a daily program of activities to meet the assessed needs of the classroom. The activities are planned weekly according to different themes and are documented on a lesson plan sheet which includes greeting line, large group language and cognitive activities, small group activities in the child's dominant language, art, music, fine and gross motor skills, creative dramatics , story tine, discovery center, math/science, health/nutrition, self help and special events, films, visitors, and field trips. b. Each teacher provides adequate material , equipment, and time for children to use small and large muscles to increase physical skills. These materials include puzzles, peg and pegboards, hammers and nails, stringing beads, blocks, water, sand and clay, scissors, exercise activities, dance, rhythm movement, and outdoor activities which include slides, swings, tricycles , jungle gyms, running, jumping, hopping and playing with a ball . c. Each teacher provides an environment in which children will develop socially by encouraging them to interact with others and get along, and help them develop mutual respect for property, rights and feelings of the group. All of the above objectives are monitored by the Education Coordinator on an on-going basis. Formal classroom observations , called Global Observations, are done twice during the program. The Education Coordinator is present in the classroom to observe the teacher, the classroom set up, and interaction with children by the teacher and teacher aide, specifically in the areas of safety, health, learning environment, cognitive, physical , social , language, creative, self concept, guidance and discipline. If a teacher is observed to be weak in any of these areas, an individual training plan is set up by the teacher and the Education Coordinator to strengthen the teacher in his/her weak area(s). This can be achieved through outside reading and/or utilizing other staff members who may be strong in that area. Informal and formal self assessments are completed by each staff member in order to find out what they feel their weak area or areas may be. 13 • 2. Goal #2: To integrate the educational aspects of the various Migrant Head Start components into the daily program of activities. Objectives (to meet goal ): a. Teachers are required to teach health lessons to the children on an on-going basis. Specifically, at least one health lesson will be included in the weekly lesson plan. Examples of health lessons are: dental health, snacks and nutrition, body parts, and self help skills. b. Brushing of teeth by children is done on a daily basis. This is monitored by individual teachers and reinforced by the Health Coordinator. c. Individual Education Plans (IEP) are required to be written on all Special Needs children by their respective classroom teacher. The IEP's will be submitted to and reviewed by the Education Coordinator and Special Needs Technician. d. Nutrition activities are incorporated into the lesson plans once a week by classroom teachers under the direction of the Health Coordinator. 3. Goal °3: r To involve parents in educational activities of the program in order to enhance their role as the principal influence on their child' s education and development. Objectives (to meet goal ): a. Parents receive weekly "Parent Letters" that are written by the teachers in order to let parents know what types of activities will be going on in their child's classroom the following week. These letters include the weekly there, day by day activities related to this theme, field trips, and activities parents can do at home to reinforce what is being taught in school . b. A Parent Booklet of activities will be provided to each parent in the program by the Education Coordinator. Specifically two (2) activities per week will be sent home with each child in relation to the weekly unit. Included in these activities will be the purpose, materials needed and the procedure to accomplish the activity. The way in which the Education Coordinator and Family Services Coordinator will evaluate the success of these Parent Booklets will be by monitoring the child's progress in school and by the documentation on the parents' monthly home in-kind report of time spent on these activities. c. Each classroom teacher is required to have two (2) parent meetings. The first meeting will be the open house at the beginning of July. A meeting will be held to discuss end of the year school activities in October. 14 4. Goal =4: To assist parents to increase their knowledge, understanding skills, and experiences related to child growth and development. This will be done in coordination with all other Head Start components. Objectives (to meet goal : a. Parenting classes are provided through the Family Services Compo- nent for all interested parents. Head Start uses the Systematic Training for Effective Parenting (S.T.E.P) curriculum for parents. b. General Education Degree (G.E.D. ) classes are provided through the Family Services Component in coordination with Aims Community College for all interested parents. c. A dental care in-service is offered for staff and Migrant Head Start/day care families in coordination with the Health and Family Services Components and Sunrise Clinic. d. A "Science and the Preschool Child" in-service is provided for all staff and parents through the Education Component. All classes, in-services, and workshops are coordinated by the Family Services, Health, and Education Components of the Weld County Head Start Program in conjunction with a variety of outside cormunity agencies. All classes, in-services and workshops are closely monitored and evaluated by the coordinators of each of the aforementioned components of the Weld County Migrant Head Start Program. 5. Goal d5: To identify and reinforce experiences which occur in the home so that parents can utilize them as educational activities for their children. Cbjectives (to meet goal ): a. The teaching staff, in coordination with the Education Coordinator, will provide activities for family members to visit the center and to share skills and experiences with the children. b. The teaching staff, in coordination with the Education Coordinator, will provide opportunities for parents to participate in cultural activities in the classroom. c. The teaching staff, in coordination with the Education and Family Services Coordinators , will utilize the parents of Head Start children as resource people to visit classrooms , give presentations, and share ideas in their area of specialized knowledge and expertise. 15 d. The teaching staff will encourage parent participation in the program activities and as members of the Parent Policy Council . The curriculum that will be implemented for the 4 year olds enrolled in the summer migrant program is the "Nuevas Fronteras de Aprendizaje". This curriculum incorporates cultural democracy within the classroom, establishing respect, awareness and understanding for cultural diversity and individual differences. In other words, it validates the childrens' home cultural diversity and also makes available to them the wider culture of their comunity. The curriculum also establishes methods and techniques of teaching children in their preferred cognitive style, working towards a bilingual/cognitive learning style. These learning styles are explained as follows: Field Sensitive Learning Style: the child learns readily if he/she can work closely with others when provided with examples and models and prefers social rewards Field Independent Learning Style: the child learns readily if he can work alone discovering how to do something in a one on one, and receive non-social rewards The philosophy of language development behind this curriculum stresses learning concepts in the childs dominant language familiarizes the child with a second language. The program's goals are designed to develop both languages through small group and large group activities. The children are introduced to concepts in their dominant language then promote the second language. With regard to child development, the children experience a full and rich program which promotes their development in psychomotor, socio-emotial and conceptual areas, so that each child will reach his/her full capacity. The specific areas addressed and monitored by the enclosed progress report are Spanish, English, pre-reading, number and othe concepts, music, social skills, large motor, and fine motor development. The curriculum that will be implemented with the 1, 2 and 3 year old children will be adapted from the Portage Guide to Early Education. In this guide, there are five basic areas of development from which skills can be taught. They are socialization, language, congitive, self-help, and motor. The progress of these skills can be recorded on the enclosed checklist. This checklist is based on the sequence of normal child development. The steps in implementing this Portage Guide are as follows: have a defined goal in mind, one that is specific and requires a response from the child; select a specific objective to be taught (for example - buttoning); select materials; have a routine time and place; use short and simple explanations and be sure to model correct responses; reward frequently at the beginning and then gradually fade out; and finally, provide many opportunities for the child to use and practice his new skills. 16 Medical Services The Weld County Head Start Program has approached the Migrant Health Department and requested the delivery of medical and dental services to migrant children during the summer of 1985. Migrant Health has agreed to work with Weld County Head Start in the event the grant is awarded. The services provided through Migrant Health will be physical examinations, dental care, medical care (prescription) , nutritional services and handicap care. During the summer months, members of the Migrant Head Start Parent Policy Council will participate in the Health Board to provide input and their recommendations. At least one meeting will take place during the summer months. The following outlines the procedures that will be used in physical examinations, vision and hearing screenings, immunizations, dental examinations and health follow-up. Also discussed are the activities of the Health Advisory Board, the school lunch program, in-service training for staff and parents, recordkeeping, goals, objectives and methods to achieve the goals and objectives. 1. Physical , vision and hearing, immunizations , and medical histories will be obtained by the Family Services Component when parents initially enrolled their children. The Health Coordinator will review the histories with each parent at the screening. Vision screening for acuity and stratismus will also be conducted during the screening process. Those children who fail the test or have 20/40 vision or worse in either eye, will be retested. If the child fails the test the second time, they will then be referred to an opthamologist for further testing, evaluation and treatment. Hearing screening will be conducted. The Puretone Audiometer will be done in sound-proof booths. An abnorral hearing will be failure to respond in either ear below 15 db at 500 cps , 1000 cps, 2000 cps and 4000 cps. Children failing this test will tested by the UNC Audiology Department. The children who fail the second test will be referred to an Ear, Nose, and Throat physician. The physician will evaluate the case, retest, and initiate any indicated treatment. Possible treatments could include myringatomy with tube placement, removal of impacted cerumen, and implantation of a selective hearing aide device. Funds for the service will be obtained from the Head Start. Program, Elks Club funds , and community contribution. Immurization statistics are obtained during enrollment and parents are informed of the new Colorado State Law. The Health Component will refer all incomplete immunizations to physicians , clinics, and the Fealth Department. At the time of enrollment, Head Start will evaluate the immunizations. Every child should have four (4) DPT' s, four (4) OPV's, and one (1) MMP by the tire he or she is four (4) years of age. When the child enters Kindergarten or Head Start, they should have the fifth DPT and OPV; however, if the doctor wants 17 a child to wait until Kindergarten, Head Start will need written verification of this. The PPD (tuberculosis) test should be given following the state guidelines. The guidelines require the test be provided to: a. Certain groups of high risk children b. Children of migrant workers. c. Children born in Mexico or other third-world countries where tuberculosis remains common. The Health Department does not recommend TB screening of 12 month old school enterers or adults who do not fit the criteria. The following staff will need TB screening: a. Teachers - yearly. b. Dietary - every 6 months. September and March, unless positive reaction, then chest x-ray. c. Coordinators and aides - yearly. d. Diversion workers - when they begin. e. Parent Policy Council - October. f. Bus Drivers - yearly. g. Volunteers - yearly (occasional volunteers, i .e. those working less that four (4) times per month will not need TB screening). 2. The Health Advisory Board will play an important role in the Health Component for the 1985 year. The Board consists of: Gilbert Sydney D.D.S. Dental Director Barbara Cos y Leon Social Worker Cheryl De Conde Johnson Audiologist Joann Harris Child Find Specialist BOCES Debbie Drew R.N. Public Health Nurse Gloria Loya Parent Policy Council Juanita Santana Head Start Director Lois Frank Special Needs Technician Dixie Hansen L.P.N. Health Coordinator Dorthey Rodman R.N. Sunrise Community Health Center, Nursing Supervisor Theresa McNeill R.N. Sunrise Community Health Center, Nurse Patsy Drewer Transportation Diane Smith Mental Health 3. The goals of the Health Component are: a. To provide a well planned health service for Migrant Head Start children, composed of a variety of health care, including medical , dental and nutritional services. b. To incorporate all components in a well established manner to form a comprehensive health service program. 18 c. To involve parents and family in preventative health service through health education. d. To work with the Health Department in giving tuberculosis immunizations to staff and children who meet the guidelines. e. To give good dental care to children of Head Start by having a hygienist/dentist give examinations and then work in a triage manner to give care needed. f. Work with the Migrant Health Department to give physicals to children. g. To give inservices to parents in basic first aid in order to help parents alleviate "runs" to the emergency room when they possibly are not needed. To teach moms and dads how to give good medical care. This will be taught in conjunction with Sunrise Community Health Center. h. To meet with the Health Advisory Board one time during the program. 4. Methods used to meet the health goals: a. Conduct physicals utilizing Sunrise Community Health Center. Head Start caters to low income families. Most of the families utilize Sunrise Community Health Center for their own use. Thus , this will help with utilizing the community resources. b. Conduct dental check-ups in the same manner as physicals. c. When the child first enters Migrant Head Start, information regarding his/her birth weight, any illnesses , allergies, family eating habits, are all reviewed. Children are weighed at the beginning and at the end of the school year. If a child is underweight and continues to be so, this will be evaluated. At the physical , each child will have a hematocrit done if questionable (less than 34) , hemoglobin will be done, and he/she will receive a urinalysis. d. Head Start will have health teachings offered to parents in the area of good preventative dental care and a first aid class for preventative medical care. e. Giving tuberculosis immunizations following the correct guidelines. f. The Parent Policy Council will be asked to utilize its expertise in advising the Health Component in developing the Health Plan and participating in the SAVI Report. 5. The Health Coordinator assures accurate records are maintained and they are kept confidential . The records are maintained in the Health Coordinator' s office, are kept locked, and are available only 19 to those authorized to see them. The Health Coordinator will keep a daily log of illnesses and any first aid given to children. Any follow-up services will also be recorded. The Health Coordinator has an emergency card concerning each child, and it is kept close to the phone. Each card contains: name, address, phone number, emergency or alternate phone number, parents name, allergies, dates of immunizations. The Health Coordinator has devised a system for keeping track of each child's medical needs. This is called the "tracking method". This will include: D.O.B. physical exam date, HCT VA, beginning weight and height, dental exams , hearing evaluation, vision evaluation and comments. • • 20 Dental Services One of the most important areas of health care for the preschool aged child is the teeth. During the Migrant Head Start school programs , each child is screened by a dentist and the treatment as prescribed is provided. Children who reside in a community with insufficient fluoride in the water supply are required to participate in a supplemental fluoride program. The Health Aide from Head Start is available to coordinate the appoint- ments and to provide transportation to the children and families, to ensure that all the children receive the treatment prescribed. 21 Mental Health Services The objective of the mental health plan of the Health Services Component is to provide for prevention, early identification and early intervention in problems that interfere with a child's development. This is accomplished by the following steps being taken: 1. The acceptance process provides for early identification of a child with a special need or handicap. All children reported as having a specific handicap must have been diagnosed by appropriate professionals who work with children having a handicapping condition or certification or licensure to make diagnosis. 2. The Weld Mental Health consultant serves as a representative on a Pre-Assessment Team to assist with assessment of individual children's emotional needs, make recommendation, and provide actual services through parenting classes, family counseling, play therapy groups, provides psychological testing, provide booklets and information to availability of services, and provide Head Start staff with workshops and inservices. 3. A University of Northern Colorado Psychology Department professor is available to provide play therapy services to Migrant Head Start families. The Weld County Head Start Program has agreements with agencies such as Weld Mental Health and the University of Northern Colorado to provide services to children and to families identified as needing mental health services. The cost is covered by Head Start. Many times the services are provided as inkind donations by private professionals in the field. All the services available are targeted not only on the child, but at the family as a unit. Parents are required to participate in the therapy and parent support groups are available to help parents to better understand and relate to the problems without feeling guilty for being "bad parents". 22 Nutrition The Weld County Head Start Program recognizes the importance of nutrition in a child' s social , emotional and intellectual development. Research points out the importance of a good balanced diet for the child to be able to interact successfully, to learn and to achieve, to have a good relationship with children his/her own age, and develop a good parallel play routine. Nutrition will continue to be a major part of the Health Component. A substantial breakfast, lunch, and snack will be provided to all children participating in the program. A committee has been set up to assist the Health Coordinator in making menus for fifteen (15) weeks. This committee consists of the Health Coordinator, cook, teachers , teacher aides , and parents. All menus include the basic four food groups and proper nutritional values for the infants, toddler, pre-Head Start and Head Start children. Menus include ethnic foods. All meals provided by Head Start to the children are nutritionally sound. No limitations are set on the amount of food the children can eat and food is not used as a punishment or reward. Some cooking experiences for the children, such as making Shamrock Bread, are conducted in the classroom. Food projects will be conducted on a bi-weekly basis and assistance will be given by the cooking staff whenever possible. In-service training is conducted for all staff members and interested parents by the Health Component in conjunction with Family Services. This is done in hopes of assisting individuals receiving food stamps to broaden their knowledge in buying good food and using it wisely. There will continue to be in-depth training for cooking staff in meal preparation, use of equipment, ordering supplies, record keeping, and the adequate use of time and surroundings. All training will include the following: 1. Four basic food groups. 2. Food preparation on the family budget. 3. The use of commodity supplemental foods. 4. Concerns expressed by Head Start parents and staff. 23 Social Services The goals and objectives of the Social Service area are: 1. To establish and maintain an outreach and recruitment process which systematically insures enrollment of eligible children. a. The Family Services staff will do on-going outreach in the community on behalf of migrant children 0 - 5 years old. These activities will involve getting out into the community and making contacts with individuals, agencies, and groups to publicize the Migrant Head Start Program. b. Recruitment activities on an on-going basis will involve seeking out those families who are most in need of support services and whose children are eligible for enrollment in Migrant Head Start. c. Utilize a community needs assessment tool to evaluate the information available on the community and the families residing in it, and to identify those families with the greatest need for Head Start. 2. To provide enrollment of eligible children regardless of race, sex, creed , color, national origin, or handicapping condition. a. In order to ensure enrollment of eligible children into Head Start, the parents, staff, and community members will be given on-going training to develop an awareness of federal rules and regulations, performance standards , and program policy. 3. To achieve parent participation in the center and home program and related activities. a. Migrant Head Start parents will be assured that their involvement would be most meaningful to them and their children. b. The parents will be involved in decision making regarding the content and operation of the program and how they and their child would participate. c. Encourage parental involvement in the classroom so they will have a better understanding of what the center is doing for their children and the kind of help the child may need at home. d. Develop parent-oriented activities which gives them on-going opportunities to learn, share, and experience personal growth. e. Encourage parental involvement in home activities in order to enhance their child's development. 24 4. To assist the family in it's own efforts to improve the condition and quality of family life. a. Social Services will utilize an assessment tool to identify the interests, desires, goals, needs , and strengths of the family. b. Assist families and individuals in developing greater independence and an increased ability in utilizing their own resources to identify and assess their needs, and to obtain the services to meet their needs. The Family Services Component provides social services to Head Start families. However, it is an all staff effort to identify families with needs. Home visits are completed by teachers, health staff, family service workers , and the Special Needs Technician. During the home visits, observations are made on the physical surroundings and the emotional/social climate between family members. A Family Services questionnaire is also done on each Head Start family as a needs assessment tool . The information gathered is reviewed, assessed, and utilized in developing a plan of action to be taken with each family. Family Services advocates for Head Start families by networking with local social service agencies , community organizations, volunteer organizations, etc. These agencies are invited to present workshops for • families at the Head Start Center and cover areas such as: nutrition, exercising, budgeting, parenting, fire/safety prevention, increasing employability skills, dealing with stress, etc. Family Services at Head Start provides direct services to families by providing free child care in order for families to attend GED classes and workshops; transportation to Head Start in order for parents to volunteer in the classroom, attend meetings, etc. ; clothing for Head Start family members; emergency loans; fees for classes; and food vouchers. These and other direct services are provided in part or all by fundraising efforts and donations from local businesses. Families are also referred to other agencies in an effort to meet their needs. Families are referred to the Salvation Army, Catholic Community Services, Seventh Day Adventist Church Clothing Bank, Weld County Department of Social Services , Weld County Department of Mental Health, Weld County Department of Public Assistance, Weld County Job Diversion Program, LEAP, Supplemental Foods, Weatherization Program, Aims Community College for GED classes , The Right to Read Program, and the Sunrise Clinic and Health Department for medical needs and follow-up. 25 Parent Involvement The goals and objectives of the Parent Involvement Area are: 1. To provide a planned program of experiences and activities which support and enhance the parental role as the principal influence in a child's education and development. a. In education, parents can be involved in activities to enhance their role as the principal influence in their child's education and development. This will be monitored through the In-Kind Documentation form that parents are required to sign each time they participate in the classroom. Teachers will be responsible to keep track of the documentation and to deliver it to the Family Services Component. Parents who fail to participate will be visited. b. In health, parents can be provided with opportunities to develop health care skills and insight into their children's health needs. Health and Family Services will work together in coordinating activities for parents. In August, there will be an emphasis on "home canning" with the assistance of the Home Extension Service. Dental will also be a topic for parents and the Sunrise Community Health Center will be assisting. The month of September will feature a workshop on nutrition in conjunction with utilizing food stamps and stretching limited incomes. c. Parent Involvement/Social Services can involve parents in experiences and activities which lead to enhancing the devel- opment of their skills, self confidence, and a sense of independence in fostering an environment in which their children can develop to their full potential . This will also enhance the parent's ability to identify their needs and to utilize community resources to meet the basic life support needs of the family. The goal is to have 10% of all parents involved in the classes or activities. The different components of the Head Start program will be working together in coordinating these. General Education Development (GED) classes and English As A Second Language (ESL) classes will be provided by Aims Community College. The Parent Involvement/Social Services Components provide a program that recognizes the parent as: . Responsible guardians of their children's well being. . Prime educators of their children. . Contributors to the Head Start Program and their communities. 26 The Parent Involvement area will implement a plan of on-going parent activities and training sessions which involve the different components also involved in the classroom participation of the child. Being involved in committees , such as the Classroom Committee Group, or in making decisions for the program, such as the Parent Policy Council , assures that the Migrant Head Start parents leave the program with confidence in themselves as persons and are therefore more effective parents. They will have developed or improved their skills to provide a better life for themselves and family as a unit. d. In administration, the parents are provided the following kinds of opportunities for participation: . Direct involvement in decision making in the program planning and operations. . Participation in curriculum planning for the classroom and other program activities that will further the Head Start child' s development. . Participation in the Community Needs Assessment. Parents will be encouraged to participate in the Parent Policy Council , and to work as paid staff in the Migrant Summer Program. Each classroom will select one parent as a representative to the Parent Policy Council . The PPC will be formed by at least 51% of migrant farm workers participating in the program. The council will meet three times during the summer and once during the winter months. The parents who live out of the state will be paid transportation and lodging to attend the meeting. The meeting will be a planning session for the following summer's program. Three family nights wil take place during the program. Each will consist of: a dinner provided by the program; speakers; film presentations; distibution of educational materials on the areas of health, parenting, services available in the community, etc. All the materials and presentations will be presented in Spanish and English. 27 Handicapped The Weld County Head Start Program will actively recruit and make available no less than 10 percent of it's total number of enrollment opportunities for handicapped children in a main stream setting. The types of handicapping conditions which will be provided services are: . Mental Retardation . Hearing Impairment . Speech Impairment . Visually Handicapped . Emotionally Disturbed . Orthopedically Impaired . Learning Disability . Other Physical/Mental/Emotional Conditions that Require Special Educational Services . Acute Dental Problems which Endanger the Child's Health 1. Planning: Referral forms stating specific concerns of individual children will be turned in by teachers in July and thereafter. The referral forms state problem areas that the teacher or others have observed. All referrals are presented to a pre-assessment team to determine if additional assessments and/or what follow-up or planning is necessary for each child. Conferences will then be arranged with parents and teachers to discuss concerns and obtain parental permission for additional assessments, if necessary. Observations are to be conducted in individual classrooms during early August and when requested. Team teaching meetings will be scheduled during the months of July through September to discuss specific needs of all children. An Individual Educational Plan ( IEP) will be completed on children who have scored low on the developmental screening, who have been identified as handicapped, or who will be provided with special services because of a specific need that is interfering with their learning. The plan will include long and short term goals, strengths and weaknesses, and will also include the date these goals are to be accomplished. The IEP will be completed by the classroom teacher, parent, and Special Needs Technician. Community resources are utilized within the Special Needs area to assist with the administering of diagnostic testing and to determine the severity of the special need or handicap present. A variety of community resources are accessible to the Weld County Migrant Head Start Program in order to provide necessary testing and to recommend needed supportive services. 28 The following agencies are utilized to assess and serve children with problems that prevent them from coping with their environment: a. The Weld County Child Find Specialist serves as a representative on the Pre-Assessment Team: . Provide additional testing if needed. . Serve as consultants to Head Start Program. . Assist with identification and provide service for children with handicapping conditions. b. A University of Northern Colorado Speech Pathologist consults with the Special Needs Technician to provide the following: . Serve as representative on Pre-Assessment Team. • Identify speech and/or language disorder of Head Start children. c. The Weld County Community Center Foundation provides information and availability of services. d. Head Start children are referred to attend an inter-agency screening held monthly to identify developmental and health needs of specific children. e. Local clinics, physicians , and dentists refer children to the Head Start Program and will at times relate information gathered during the physical and oral examination. 2. Information Sharing/Parent Contact: A group of the most severly handicapped and/or special needs children will be identified and monthly home visits or in-school conferences will be scheduled. The Special Needs Technician will assess the needs of these families and children and will work closely with Family Services to provide workshops, support groups, "rap sessions", social get-togethers , etc. There will be coordination of services between community resources from the University of Northern Colorado, and Weld Mental Health. The Special Needs Technician coordinates necessary staffings with teaching teams, parents , and necessary Head Start staff. The staffings provide an opportunity to share information gathered and recommendations made with the parent and classroom teacher. Once testing is completed, a staffing is held. 3. Services: The Speech and Language Department at the University of Northern Colorado provide the following services via contract: a. Develop individualized programs for those children with speech and language needs. 0 b. Work closely with teaching teams and parents to implement individual programs. At least two (2) home visits are made to each family whose child is receiving speech therapy during the year. c. Provide one-to-one therapy to those children with the most severe problems. a. Provide and assist teaching staff and parents with specific language stimulation activities to be completed. e. Assess each child to determine their language dominance and to insure that appropriate language stimulation is provided. 4. Transportation: Services are available through the Transportation Department of the Weld County Division of Human Resources. Any additional transportation needs are provided by the appropriate coordinator or therapist. 30 C. Needs Assessment, Screening, etc. : The information identified in each component area provides the requested information for this section. D. Resources: The Weld County Division of Human Resources Migrant Head Start Program has always utilized volunteers to assist in carrying out the needs of the program. This will continue. Examples of the volunteers used include: (1) Parents Parents will be requested to volunteer eight hours a month. If the parent cannot come to their respective center, they are provided materials at home to complete. The parents assist in every component area and have been essential in teaching, coordinating transporta- tion, helping with developmental screenings, providing bilingual/bi-cultural materials, etc. There is simply not one area the parents are involved in. Again, this encouragement for active involvement is in line with the Head Start philosophy. (2) Professionals On numerous occasions professionals in the field of medicine, dentistry, psychology, special education, etc. donate their services to assist in providing therapy for the children. (3) Educators The University of Northern Colorado will provide students to assist in Head Start functions. The students specialize in a variety of educational majors and bring the state of the art teaching techniques to the center. (4) Agencies Coordination with local agencies has secured the regular Head Start's position within the community. On page 2 are listed the the agencies that are key in coordinating their time and services with Head Start. It is a continuing effort to keep parents , professionals, educators and agencies involved so that the Head Start Program can provide quality services to the children and their families. 31 All services that are not provided by the Migrant Head Start Program will warrant referral to the appropriate agency. 4. Geographic Location: A map of the area to be served is Attachment 4. The Weld County Division of Human Resources Head Start Program's staffing pattern, both racially and ethnically, has always reflected the communities being served. The latest statistics within the Weld County Head Start Program revealed 73% of the children enrolled were of Mexican American descent. The staff is composed of 70% Mexican American descent individuals. It is anticipated that the migrant Head Start in northern Weld County will be nearly 100% Spanish/Mexican American. The Migrant Head Start Center in southern Weld County and Adams County will be approximately 85% Spanish/Mexican American and 15% Kickapoo Indian. The title and location of the grantee is: Weld County Division of Human Resources Head Start Program P.O. Box 1805 1516 Hospital Road Greeley, CO 80632 Correspondence should be addressed to Walter J. Speckman, Executive Director. The center location to service southern Weld County and Adams County has not been finalized at this time. Efforts will be made to locate an appropriate center as soon as finalization and confirmation of this grant application is received. 32 PART V ASSURANCES The Applicant hereby assures and certifies that he will comply with the regulations, policies, guidelines and requirements, including 45 CFR Part 74, and OMB Circulars No. A-102 and A-110, as they relate to the application,acceptance and use of Federal funds for this federally-assisted project.Also the Appli- cant assures and certifies to the grant that: 1. It possesses legal authority to apply for the 5. It will comply with the provisions of the Hatch grant;that a resolution, motion or similar ac- Act which limit the political activity of tion has been duly adopted or passed as an employees. official act of the applicant's governing body, authorizing the filing of the application, in- 6. It will comply with the minimum wage and cluding all understandings and assurances maximum hours provisions of the Federal Fair contained therein,and directing and authoriz- Labor Standards Act,as they apply to hospital ing the person identified as the official and educational institution employees of representative of the applicant to act in con- State and local governments. nection with the application and to provide such additional information as may be 7. It will establish safeguards to prohibit required. employees from using their positions for a purpose that is or gives the appearance of 2. It will comply with Title VI of the Civil Rights being motivated by a desire for private g:?in Act of 1964(P.L. 88-352) and in accordance for themselves or others, particularly those with Title VI of that Act, no person in the with whom they have family, business, or United States shall, on the ground of race, other ties. color,or national origin,be excluded from par- I ticipation in, be denied the benefits of, or be 8. It will give the sponsoring agency or the otherwise subjected to discrimination under Comptroller General through any authorized, any program or activity for which the appli- representative the access to and the right to cant receives Federal financial assistance examine all records, books, papers, or and will immediately take any measures documents related to the grant. necessary to effectuate this agreement. 9. It will comply with all requirements imposed 3. It will comply with Title VI of the Civil Rights by the Federal sponsoring agency concern- Act of 1964 (42 USC 2000d) prohibiting ing special requirements of law, program re- employment discrimination where (1)the quirements, and other administrative primary purpose of a grant is to provide requirements. employment or(2) discriminatory employment practices will result in unequal treatment of 10. It will insure that the facilities under its owner- persons who are or should be benefiting from ship, lease or supervision which shall be the grant-aided activity. utilized in the accomplishment of the project are not listed on the Environmental Protec- 4. It will comply with requirements of the provi- tion Agency's(EPA) list of Violating Facilities sions of the Uniform Relocation Assistance and that it will notify the Federal grantor and Real Property Acquisition Act of 1970 agency of the receipt of any communication (P.L. 91-646) which provides for fair and from the Director of the EPA Office of Federal equitable treatment of persons displaced as Activities indicating that a facility to be used a result of Federal and federally-assisted in the project is under consideration for listing programs. by the EPA. 33 The phrase"Federal financial assistance"includes adverse effects (see 36 CFR Part 800.8) by any form of loan, grant, guaranty, insurance pay- the activity and notifying the Federal grantor ment, rebate, subsidy,disaster assistance loan or agency of the existence of any such proper- grant,or any other form of direct or indirect Federal ties, and by (b) complying with all re- assistance. quirements established by the Federal grantor agency to avoid or mitigate adverse 11. It will comply with the flood insurance pur- effects upon such properties. chase requirements of Section 102(a) of the Flood Disaster Protection Act of 1973, Public 13. Applicants for the Administration for Native Law 93-234, 87 Stat. 975, approved Decem- Americans Programs, hereby certify in ac• bee 31, 1976.Section 102(a)requires,on and cordance with 45 CFR 1336.53,that the finan- after March 2, 197'5,the purchase of flood in cial assistance provided by the Office of surance in communities where such in- Human Development Services for the speci- surance is available as a condition for the fled activities to be performed under this pro- receipt of any Federal financial assistance for gram, will be in addition to, and not in construction or acquisition purposes for use substitution for, comparable activities pro- in any area that has been identified by the vided without Federal assistance. Secretary of the Department of Housing and 14. It will comply with the Age Discrimination Act Urban Development as an area having spe- of 1975 which provides that: No person in the cial flood hazards. United States shall,on the basis of age be ex- cluded from participation in, be denied the 12. It will assist the Federal grantor agency in its benefits of,or be subjected to discrimination compliance with Section 106 of the National under, any program or activity for which the Historic Preservation Act of 1966 as amended applicant receives Federal financial (16 U.S.C.470),Executive Order 11593, and assistance. the Archeological and Historic Preservation Act of 1966 (16 U.S.C. 469a-1 et seq.) by 15. It will comply with Section 504 of the (a) consulting with the State Historic Preser- Rehabilitation Act of 1973, as amended (29 vation Officer on the conduct of investiga- U.S.C. 794), all requirements imposed by the tions, as necessary, to identify properties applicable HHS regulation (45 C.F.R. Part listed in or eligible for inclusion in the National 84), and all guidelines and interpretations Register of Historic Places that are subject to issued pursuant thereto. II '1 DFP.%RTMENT OF HEALTH AM) HL:`•? .V RVICES ASSURANCE OF COMPLIANCE w ITH SECTION 504 OF THE REHABILITATION ACT OF 19'3.AS AMENDED The undersi;led Lereihafter .rhd the "recipient") HEREBY AGREES T:1=.- .: -.1 comply with section 504 of the Re- • Itahilitath n Ac: -47,. as ee.esded (—'9 U.S.C. "9-1).all recr-_- -_ _rplicabte HHS regulation(45 C.F.R. Part 84). and ad _•_;..itha.es ar._ interpretations issued pursuant Pursuant to C S4.5._i u: :he •e ilation [45 C.F.R. 845(a)] . the :e - - _s Asssrance in consideration of and for the purpose of c - .fir.::_ _ __ federal grants loans,contracts i_ --:__: -__: contracts and contracts of insurance or guaranty). prop::: _o_r-u.or other federal financial assts:4r_ . .._r__ The Department of Health and Human Services after the __._ is, .4ssurance. including payments or -, ___ 7__e after such date on applications for federal fina ci_. osSiStal7e the: were approved before such date. Tie _ so-.. :es and agrees that such federal financial assistance vv ,: :xte _ ::n r_:..ince on the re_resentations and - _r_. - .-. '.Ids Assurance and that the Unfired States will hake c.. rizht to enforce this Assurance through law:,'. Bans. Tb: Asvralt_e is binding on the recipient, its successors. trae4 ---s -_ ss'._nees.and the person or persons c;se s_ ___ _- e..r below are authorized to sign this Assurance on oel.-o_. ... the. re -lent. This Assurance < r :_- .. ^lent for the period during which : _. - ss:stance is extended to it by the De- partment of Haiti. at:d H,un_ Services or, where the assistance Is Ir. the ::T, '_:.,I or personal property, for the period provided for in 84.5i b of the regulation [45 C.F.R.84.5(b)1 . The recipient: [Check I a. or a, ( ) employs fewer than fifteen persons: A73 b. ( X ) emr:o}s fifteen or more persons and. pursuant to rec:;lation [45 C.F.R. 84.7(a)] ,has A74 desi_r.ated the following person/sl to coordinate its .i: : :--, with the HIIS regulation: Weld County Commissioners Name of Designee(s) ---Type or Not c i: C42 Weld County Division of Human Resources P.0.._Box_1895_ Name of Recipient —T.::e or Print Street A ::esa or F.O. Box Al2 A41 A42 A71 84-6000813 _ _-_ Greeley (IRS)Employer Identification Number C1:4.- Al All B!' 841 BI B11 Colorado 80632 Cl CII S.-__ Zip. B4.2 B71 I certify that the above informa:4m is complete and correct to tb: \- 06/03/85 - - -- Date Signature _-. ' Ta.e -: -.2_;i Official B72 EIT acqueline Johnson, Chairman Weld County Board of Commissioners If there has been a .±.-Lrizein name or ownership -.vithin the last }e-. . loaner name below. NOTE: The . 'B . are C ll;-:..:d be numbers re for compute: _. - PLEASE RETURN ORIGINAL. TO: Office for (Thal R Jits Root _ `>0 lndependenc; Avenue NN., Washington. D.C. '02201. RETURN COPY 10: G:_,:s Ala::'_ement Office AN IS NIANAGLIMII NT HHS-641 10/821 REV. 34 • ASSURANCE OF COMPLIANCE WITH THE DEPARTMENT OF HEALTH AND HUMAN SERVICES REGULATION UNDER TITLE VI OF THE CIVIL RIGHTS ACT OF 1964 Weld County Commissioners/Division of Human hereinafter called the "Applicant") (Name orAR6tettlrces HEREBY AGREES THAT it will comply with title VI of the Civil Rights Act of 1964 (P.L. 88-352) and all requirements imposed by or pursuant to the Regulation of the Department of Health and Human Services (45 CFR Pan 80) issued pursuant to that title, to the end that, in accordance with title VI of that Act and the Regulation, no person in the United States shall, on the ground of race, color, or national origin, be excluded from participation in, be denied the benefits of, or be otherwise subjected to discrimination under any program or activity for which the Applicant receives Federal financial assistance from the Department; and HEREBY GIVES ASSURANCE THAT it will imme- diately take any measures necessary to effectuate this agreement. If any real property or structure thereon is provided or improved with the aid of Federal financial assistance extended to the Applicant by the Department. this assurance shall obligate the Applicant, or in the case of any transfer of such property, any transferee, for the period during which the real property or structure is used for a purpose for which the Federal financial assistance is extended or for another purpose involving the provision of similar services or benefits. If any personal property is so provided, this assurance shall obligate the Applicant for the period during which it retains ownership or possession of the property. In all other cases, this assurance shall obligate the Applicant for the period during which the Federal financial assistance is extended to it by the Department. THIS ASSURANCE is given in consideration of and for the purpose of obtaining any and all Federal rants, loans, contracts, property, discounts or other Federal financial assistance extended after the date hereof to the Applicant by the Department, including installment payments after such date on account of applications for Federal financial assistance which were approved before such date. The Applicant recognizes and agrees that such Federal financial assistance will be extended in reliance on the representations and agreements made in this assurance, and that the United States shall have the right to seek judicial enforcement of this assurance. This assurance is binding on the Applicant, its successors, transferees, and assignees, and the person or persons whose signatures appear below are authorized to sign this assurance on behalf of the Applicant. Weld County Commissioners Dated 06/03/85 Weld County Division of Human Resources (Applicant) (Pr ',dent, :f B•ar•,or comparable author::.: official) Jacqueline Johnson, Chairman Weld County Board of Commissioners P.O. Box 1805 Greeley, Colorado 80632 (Applicant's railing PLEASE RETURN ORIGINAL TO: Office of Civil Rights Room 5627/B North Building 330 Independence Ave.. N.W. Washington, D.C. 20201 RETURN COPY TO: GRANTS MANAGEMENT OFFICE NDS GRANTS MANAGEMENT HHS-441 (10/B2) Rev. GPO 894-600 35 CERTIFICATION OF HEAD START ADMINISTRATIVE COSTS We Weld County Commissioners - Weld County Division of Human Resources , have reviewed /Name of Grange') 45 CFR Part 1301.32 and certify that the development and administrative costs to administer the Weld County Division of Human Resources MigrantHead Start Program for the program year (Name of Gowen June 37. 1985 through aher . 198 755 will, not exceed 15 percent of $ 308,899.00 D (total Federal and non-Federal costs for program accounts 22 through 26). Documents substantiating administrative costs are available in our files for review by auditor and Office of Human Development Services/Health and Human Services Personnel. b � �. --- 06/03/85 . Sig a -, Certifying Official Date Jacqueline Johnson, Chairman Weld County Board of Commissioners lIDS GRANTS MANAGEMENT 36 5. INVESTIGATIONAL NEW DRUGS-ADDITIONAL CERTIFICATION REQUIREMENT SECTION 46.17 OF TITLE 45 OF THE Code of Federal Regulations states, "Where an oremtitaion is required to prepare or to submit a cer- tification....and the proposal involves an investigational new drug within the meaning of The Food,Drug,and Cosmetic Act,the drug shall be identified in the certijicatior together with a statement that the 30-day delay required by 21 CFR 130.3(4(2)has elapsed and the Food and Drug Administration has not,prior to expiration of such 30-day interval,requested that the sponsor continue to withhold or to restrict use of the drug in human subjects:or that the Food and Drug Administration has malted the 30dc-delay requirement provided,however,:bar in those cases in which the 30-day deter interval has neither expired nor been waived,a statement shall be forwarded to DHHS upon such expira- tion or upon receipt of a waiver.No certification shall be considered acceptable until such smtement has been received" INVESTIGATIONAL NEW DRUG CERTIFICATION TO CERTIFY COMPLIANCE WITH FDA REQUIREMENTS FOR PROPOSED USE OF INVESTIGATIONAL NEW DRUGS IN ADDITION TO CERTIFICATION OF INSTITUTIONAL REVIEW BOARD APPROVAL THE FOLLOWING REPORT FORMAT SHOULD BE USED FOR EACH IND: (ATTACH ADDITIONAL IND CERTIFICATIONS AS NECESSARY). - IND FORMS FILED: D FDA 1571, LI FDA 1572, 0 FDA 1573 - NAME OF IND AND SPONSOR - - DATE OF 30-DAY EXPIRATION OR FDA WAIVER (FUTURE DATE REQUIRES FOLLOWUP REPORT TO AGENCY) — FDA RESTRICTION — SIGNATURE OF INVESTIGATOR - DATE 6. COOPERATING INSTITUTIONS-ADDITIONAL REPORTING REQUIREMENT SECTION 46.16 OF TITLE 45 OF THE Code of Federal Regulations IMPOSES SPECIAL REQUIREMENTS ON THE CONDUCT OF STUDIES OR ACTIVITIES IN WHICH THE GRANTEE OR PRIME CONTRACTOR OBTAINS ACCESS TO ALL OR SOME OF THE SUBJECTS THROUGH COOPERATING INSTITUTIONS NOT UNDER ITS CONTROL. IN ORDER THAT THE DHHS BE FULLY INFORMED,THE FOLLOWING REPORT IS REQUESTED WHEN APPLICABLE. USE FOLLOWING REPORT FORMAT FOR EACH INSTITUTION OTHER THAN GRANTEE OR CONTRACTING INSTITUTION WITH RESPONSIBILITY FOR HUMAN SUBJECTS PARTICIPATING IN THIS ACTIVITY: (ATTACH ADDITIONAL REPORT SHEETS AS NECESSARY). INSTITUTIONAL AUTHORIZATION FOR ACCESS TO SUBJECTS — SUBJECTS: STATUS(WARDS,RESIDENTS. EMPLOYEES,PATIENTS,ETC.) NUMBER • AGE RANGE NAME OF OFFICIAL.(PLEASE PRINT) TITLE - TELEPHONE NAME AND ADDRESS OF COOPERATING INSTITUTION — OFFICIAL SIGNATURE NOTES: (e.g..report of modification in proposal as submitted to agency affecting human subjects involvement) HHS-596(Rev.5-80)(Back) DEPARTMENT OF HEALTH AND HUMAN SERVICES IL GRANT ❑ CONTRACT ❑ FELLOW ❑OTHER PROTECTION OF HUMAN SUBJECTS ❑ NEW O RENEWAL O CONTINUATION ASSURANCE/CERTIFICATION/DECLARATION APPLICATION IDENTIFICATION NUMBER(If known/ in ORIGINAL O FOLLOWUP ❑ REVISION STATEMENT OF POLICY: Safeguarding the rights and welfare of subjects at risk in activities supported under grants and contracts from DHHS is primarily the responsibility of the institution which receives or is accountable to DHHS for the funds awarded for the support of the activity.In order to provide for the adequate discharge of this institutional responsibility,it is the policy of DHHS that no activity involving human subjects to be supported by DHHS grants or contracts shall be undertaken unless the Institutional Review Board has reviewed and approved such actt={ry,and the institution has submitted to DHHSa certification of such review and approval,in accordance with the requirements of Public Law 93-348,as implemented by Part 46 of Title 45 of the Code of Federal Regulations.as amended,(45 CFR 46).Administration of the DHHS policy and regula- tion is the responsibility of the Office for Protection from Research Risks,National Institutes of Health,Bethesda,MD 20205.1.eTIT OF PROPOSAL OR ACTIVITY Weld Start/Day Care Walter J. Speckman, Executive Director 2. PRINCIPAL INVESTIGATOR/ACTIVITY DIRECTOR/FELLOW 3. DECLARATION THAT HUMAN SUBJECTS EITHER WOULD OR WOULD NOT BE INVOLVED ❑ A. NO INDIVIDUALS WHO MIGHT BE CONSIDERED HUMAN SUBJECTS,INCLUDING THOSE FROM WHOM ORGANS,TISSUES, FLUIDS.OR OTHER MATERIALS WOULD BE DERIVED.OR WHO COULD BE IDENTIFIED BY PERSONAL DATA,WOULD BE INVOLVED IN THE PROPOSED ACTIVITY.(IF NO HUMAN SUBJECTS WOULD BE INVOLVED,CHECK THIS BOX AND PRO- CEED TO ITEM 7.PROPOSALS DETERMINED BY THE AGENCY TO INVOLVE HUMAN SUBJECTS WILL BE RETURNED.) rryy--II L'U B. HUMAN SUBJECTS!y�� WOULD BE INVOLVED IN THE PROPOSED ACTIVITY AS EITHER:LJ NONE OF THE FOLLOWING,OR ti INCLUDING: MINORS,❑ FETUSES,❑ ABORTUSES,❑ PREGNANT WOMEN,O PRISONERS,O MENTALLY RETARDED.❑ MENTALLY DISABLED.UNDER SECTION 6.COOPERATING INSTITUTIONS,ON REVERSE OF THIS FORM, GIVE NAME OF INSTITUTION AND NAME AND ADDRESS OF OFFICIAL(S)AUTHORIZING ACCESS TO ANY SUBJECTS IN FACILITIES NOT UNDER DIRECT CONTROL OF THE APPLICANT OR OFFERING INSTITUTION. I . 4. DECLARATION OF ASSURANCE STATUS/CERTIFICATION OF REVIEW ❑ A. THIS INSTITUTION HAS NOT PREVIOUSLY FILED AN ASSURANCE AND ASSURANCE IMPLEMENTING PROCEDURES FOR THE PROTECTION OF HUMAN SUBJECTS WITH THE DHHS THAT APPLIES TO THIS APPLICATION OR ACTIVITY.ASSUR- ANCE IS HEREBY GIVEN THAT THIS INSTITUTION WILL COMPLY WITH REQUIREMENTS OF DHHS Regulation 45 CFR 46, THAT IT HAS ESTABLISHED AN INSTITUTIONAL REVIEW BOARD FOR THE PROTECTION OF HUMAN SUBJECTS AND, WHEN REQUESTED,WILL SUBMIT TO DHHS DOCUMENTATION AND CERTIFICATION OF SUCH REVIEWS AND PROCE- DURES AS MAY BE REQUIRED FOR IMPLEMENTATION OF THIS ASSURANCE FOR THE PROPOSED PROJECT OR ACTIVITY. ® B. THIS INSTITUTION HAS AN APPROVED GENERAL ASSURANCE(DHHS ASSURANCE NUMBER )OR AN AC- TIVE SPECIAL ASSURANCE FOR THIS ONGOING ACTIVITY,ON FILE WITH DHHS.THE SIGNER CERTIFIES THAT ALL ACTIVITIES IN THIS APPLICATION PROPOSING TO INVOLVE HUMAN SUBJECTS HAVE BEEN REVIEWED AND APPROVED BY THIS INSTITUTION'S INSTITUTIONAL REVIEW BOARD IN A CONVENED MEETING ON THE DATE OF 06/0l/R5 IN ACCORDANCE WITH THE REQUIREMENTS OF THE Code of Federal Regulations on Protection of Human Subjects 4$CFn 46). THIS CERTIFICATION INCLUDES,WHEN APPLICABLE, REQUIREMENTS FOR CERTIFYING FDA STATUS FOR EACH IN- VESTIGATIONAL NEW DRUG TO BE USED(SEE REVERSE SIDE OF THIS FORM). THE INSTITUTIONAL REVIEW BOARD HAS DETERMINED,AND THE INSTITUTIONAL OFFICIAL SIGNING BELOW CONCURS THAT: EITHER HUMAN SUBJECTS WILL NOT BE AT RISK: OR ❑ HUMAN SUBJECTS WILL BE AT RISK. 5.AND 6. SEE REVERSE SIDE Weld County Division of Human Resources - Head Start Program 7. NAME AND ADDRESS OF INSTITUTION Walter J. Speckman. Fxecutive Director 8. TI LE F INST TUTIONAL OFFICIAL TELEPHONE NUMBER (303) 353-0540 G TURE INSTITUTIONAL OFFICIAL DATE 06/03/85 HH :595( J 5-80) ENCLOS IS FORM WITH THE PROPOSAL OR RETURN IT TO REQUESTING AGENCY. 37 ATTACIV1ENT 1 DEPARTMENT OF HUMAN RFSOUFr F r ,V aCgeELrY CJL( ZA_ r .S f COLORADO June 3, 1985 Mr. Robert Foster, Acting Chief ACYF - Head Start Bureau 400 6th Street, S.W. Washington, D.C. 20201 Dear Mr. Foster: The Job Service of Colorado for Weld County supports the Migrant Head Start Program being run by Weld County. This particular Job Service office is administratively under the aus- pices of the Weld County Commissioners. The opportunity to forge a close and effective coordination effort between the two programs has been a goal of both agencies. Working closely with the Migrant Head Start Program will be especially critical this season. The farmers in Weld County lost in their attempt to buy out four sugar beet factories. This means a dramatic change in life styles to all individuals involved in agriculture in Weld County. Unfortunately, the individuals who could be in the most immediate need of assistance will be the migrants. The migrant workers that are anticipated in the northern Colorado area will arrive late (i .e. , mid-June as opposed to early April ) and will stay until mid-October. The need to provide child care, housing, and employment opportunities will be critical . Sincerely, ' �dy�. Gri� Jib Service Manager JAG/dt 38 ATTACHMENT 2 1985 Migrant Head Start/Day Care (PA 23) CCFP Personnel Salaries , Administration $ 21,870 Salaries, Staff * 147,367 $ 12,320 Salaries, Transportation 20,340 $189,577 $ 12,320 * Salaried staff listed on the following page Fringe Benefits Workmen's Compensation $ 1,000 $ 60 Health, Life Insurance 16,405 673 FICA 14,000 869 $ 31,405 $ 1,602 Travel Nurse 5,000 m x .20 $ 1,000 Parent Coordinator, 6,000 m x .20 1,200 Center Director, 2,000 x .20 400 $ 2,600 Supplies Food $ 15,578 Office Supplies $ 200 Janitorial Supplies 800 Classroom Supplies 10,000 Medical/Dental Supplies 2,000 $ 13,000 $ 15,578 Other Gas & Oil $ 10,000 Vehicles Repair and Maintenance 5,000 Laudry Supplies 1,500 Postage 100 Telephone 1,600 Parent Activities 3,000 Building Rent 12,000 Utilities 3,000 Equipment Rent 3,000 $ 39,200 39 Contractual Dental Hygienist -• 20% of time $ 1,040 Medical Services -• $10 x 200 children 2,000 Dental Services - $25 x 100 children 2,500 Nutrition Services - $10 x 60 children 600 $ 6,140 Total Program Expenditures $281,922 $ 29,500 Plus: Anticipated CCFP Reimbursement 29,500 Net Federal Expenditures $311,422 The cost of developing and administering the Migrant Head Start/Day Care Program will not exceed 15% of the total cost of the program. Salaried Staff for Northern Center Salaried Staff for Southern Center Director Director Education Coordinator Education Coordinator Social Services/ Parent Social Services/ Parent Involvement Coordinator Involvement Coordinator Health Coordinator 2 - Social Services Aide Social Services Aide Health Manager 6 - Teachers Health Manager Aide 6 - Teacher Aides 6 - Teachers Cook 6 - Teacher Aides Cook Assistant Cook Office Technician II Cook Assistant Janitor Janitor 40 ATTACHMENT 3 Migrant Handicap (PA 26) Personnel Salaries $ 12,470 Fringe Benefits 1,621 $ 14,091 Equipment 2,886 Contractual 10,000 $ 26,977 Salaried Staff Positions Special Needs Technician Special Needs Aide 41 ATTACHMENT 4 : :ii5iiii :ii `::i ::ii : :::iii::ii i2ii: Y 1,1::::::-...:::::: 4 i::::-::•:�:::iv::is •: _•:::::•}:}:•:::-: 3 7.-.-:-i:}: :<::.}:}:•if .:;..X::-Y:X -X-X:_ yy w a+ .............. :: ... •>i::::L}':::• '{L {i •: i}??iv:v:•::::•:}::}: :v ?v:•:'r::4:i•::v: :{.ii::: Q,??: •:i:? iii??}} }: }:{•:{{::•:fv:;•}}:':•}:• 8: Y ... .Y:??:::><i:: -{ :1}}}:• is}}:•}}:-i: C•:�-. a : ::.} {ii:•: z V' O ill.::::11:::!::::::::::::::;::::::::::::;;;-:;;;;;11:;t1:::::;::::::;::;;:t11.:.1.:::;:;11:•:1::::;:::::•:::::::::::::J ::.:c::.:•0 ::is2:i:= :i ::f:i c:i:c: :: ::i:5 i: .: ::: :: 'i: .,-;:c j!c: :, r:i-;:s.i � c :: :::+»:•>- r • :; :iii::-: :a:_:-:i, y;. :`:: :: 'h O ya 4 C^ t L- J, la i .t% a a Dia :•}. ::}:• ® a- J� :::.:•}:::•}:.: W •: j g g 0 +� G2 I 6 W Q • .�e It:4 i:4 .......:.,:::: < v ;b:::: ;: i:r':i;`•i::�y`�::: r i: :: : i• .".: S>irt� >: : ct=ii :: W Et z • C • p a O -: - ry(. '�- Y�`' < ll la W µ, r N :;•:::c:::y::v b . - 1 : 2 .... - z ..:{tiv::•:•:?v z z h n < D . a $ii :':'`' :;S.: y...}iS :Jii}}::i}i??M1ii.`iC:}: � J Yiia }il viii?i: is?i:'L ]: ¢ apppp.. _ SIC?:i?:'::•ii:':':': �C•i:{-:::. _ jJ. 7Q ':' ::' �:i:•�'.:•: :':•:.•i:•!.. ......................... ::..4:.::.5f.:::: :'•1:.: i:'::•:::•:• i 42 ATTACINENT 5 POLITICAL SUBDIVISION EXEMPTION CERTIFICATE (For use by States, Territories, or Political Subdivision thereof, or the District of Columbia) The undersigned hereby certifies that he or she is COMPTROLLER Title of Officer of WELD COUNTY COLORADO State, territory, or-Political Subdivision, or District of Columbia and that he or she is authorized to execute this certificate, and that the articles specified in the accompanying order or on the reverse side hereof, are purchased .from VELD COUNTY GOVERNMENT for the exclusive use of BELD COUNTY GOVERNMENT Department • • of WELD COUNTY COLORADO State, Territory, or Political Subdivision, or District of Columbia It is understood that the exemption from tax in the case of sales or articles under this exemption certificate to the State, Territory, or Political Subdivision, or District of Columbia, is limited to the sale of the articles purchased for their exclusive use, and it is agreed that if articles purchased tax-free under exemption certificates are used otherwise or are sold to employees or others, such fact must be reported to the manufacturer of the articles covered by this certificate. It is also understood that the fraudulent use of this certificate to secure exemption will subject the undersigned and all guilty parties to a fine of not rxlre than $10,000.00 or to imprisonment for not more than five years, or both, together with costs of prosecution. COLORADO SALES TAX CERTIFICATION'OF EXEMPTION NUMBER - 98-03551 FEDERAL TAX EXEMPTION NUMBER - 84-6000-813 STATE TAX EXEMPTION NUMBER - 14-02-101 Date NOVEMBER 7 ,19 84 By <1/17g7#/ 43 ATTAMIENT 6 . - -- - U.S.DEPARTMENT OF HEALTH AND HUMAN SERVICES OMB APPROVAL NUMBER 0980-G)17 OFFICE OF HUMAN DEVELOPMENT SERVICES Expiration Dete 9130185 ADMINISTRATION FOR CHILDREN, YOUTH AND FAMILIES PROJECT HEAD START . 5 ANNUAL PROGit A - INFORMATION REPORT One separate Form must be completed for each grantee and each delegate agency. DO NOT combine grantee and delegate agency data on one report. 1. Name of Grantee or Delegate Agency for which this Report is submitted: Please Do Not Remove or Cover Label • • 08081500 • • WELD COUNTY HEAD START • Correct as Necessary in 520 13TH AVENUE Space Provided GREELEY CO 80632 Below Name of Agency Weld County Head Start Street Address, P.O. Box, etc. 520. 13th. Avenue City or Town: Greeley State: Colorado Zip Code: 8 0 6 3 1 2. GRANTEE INFORMATION: (If Item 2.A is the same as above, put "same". Item 2.6 must be filled in) A. Grantee Name: Weld Board of County Commissioners Street Address- P. O , Box 758 -11 City Greeley State- Colorado Zip Code:LG IQ 1613 B. Telephone Number:(303) 353-0.540. Executive Director Walt Speckman _( Head Start Grant Number: 0 8 C H 0 0 1 9 C. (For grantees only) Number of Delegate Agencies 0 0 0 0 • J 3. AGENCY DESCRIBED IN THIS REPORT IS: (Check the phrase which describes the agency named In item 1.) 1. GRANTEE WHICH DIRECTLY OPERATES ji 3 DELEGATE AGENCY (Complete all items.) PROGRAM(S) (Includes grantees which both directly operate programs and main- tain central office staff.Complete all items.) • ❑ 2. GRANTEE WHICH MAINTAINS CENTRAL 4. GRANTEE WHICH DELEGATES ALL OF ITS OFFICE STAFF ONLY-OPERATES NO PROGRAMS-OPERATES NO PROGRAMS PROGRAMS DIRECTLY (Complete Items 1 DIRECTLY AND 'AAINTAINS NO CENTRAL through 4, 6, 37 and 38.) OFFICE STAFF (Complete Items 1 through 44 4, 37 and 38.) LEAVE NO ITEM BLANK 4. TYPE OF AGENCY COMPLETING THIS REPORT: ❑ 1. COMMUNITY ACTION AGENCY 87 4. LOCAL GOVERNMENT ❑ 2. SCHOOL SYSTEM AGENCY (Non-CAA) (PUBLIC/PRIVATE) 0 5. Other (Specify) ❑ 3. PRIVATEIPUBL.IC NON-PROFIT (Non-CAA)(e.g., churches, universities, etc.) 5. AREA SERVED (Check the boxes which best describe the area you serve. See instructions for definitions. Check all that apply.) R) 1. URBAN - ❑ 2. NON-URBAN, BUT LOCATED WITHIN METROPOLITAN AREA 27 3. RURAL • 6. STAFF INFORMATION A. NUMBER OF STAFF(Enter the total number of part-time and full-time staff paid from all sources (e.g., ACYF, USDA, etc.) who were employed in your Head Start program(s) for more than half of the time your classrooms were in operation. For example, if your classrooms operate eight months, you would count all staff who were employed for more than four months. Count all part-time and full-time staff members regardless of hours worked. Include all classroom staff, home visitors, and others, e.g., bus drivers, office staff, etc. Do not include substitutes, consultants, student Interns or trainers.) 6A1. NUMBER OF PARTTIME STAFF I I I JO I 6.A.2. NUMBER OF FULL TIME STAFF I I 13_14 I 6.A.3. TOTAL STAFF (This is the sum of 6.A.1. and 6.A.2.) I I Ilk B. OF THE TOTAL NUMBER OF STAFF IN 6.A.3.,THE NUMBER OF STAFF WHO ARE HEAD START PARENTS (Include all staff members whose children are current or former par- ticipants in Head Start.) I I I i 1z_I \ l COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER,ZERO OR NA 2 LEAVE NO ITEM BLANK 6. STAFF INFORMATION (continued) C. OF THE TOTAL NUMBER OF STAFF IN 6.A.3., THE NUMBER OF STAFF WHO JOINED YOUR PROGRAM THIS YEAR L-..-I L 18J SECTION A. PROGRAM SERVICES 7. CLASSROOM STAFF INFORMATION(Include all part-time and full-time staff paid from all sources who were with your Head Start program for more than half of the time your classrooms were in operation.) 7.A. NUMBER OF CLASSROOM STAFF, i.e., total number of teachers and teachers' aides. 7.B. OF THE CLASSROOM STAFF in 7A, THE NUMBER WITH ONLY A CDA CRE- DENTIAL(Enter the number of classroom staff who have the Child Development Associate (CDA) Credential.) ( I L 19 1 7.C. OF THE CLASSROOM STAFF in 7.A., THE NUMBER WITH ONLY A DEGREE IN EARLY CHILDHOOD EDUCATION (Enter the number of classroom staff with Bachelor or advanced degrees in early childhood education awarded by an ac- credited college or university. See definition in instructions.) 1 1 1 10 7.D. OF THE CLASSROOM STAFF IN 7.A.,THE NUMBER WITH ONLY A TWO YEAR DEGREE IN EARLY CHILDHOOD EDUCATION 11 1 1 1 i 7.E. OF THE CLASSROOM STAFF IN 7.A., THE NUMBER WITH A DEGREE (BACHELOR'S OR ADVANCED) IN AREAS OTHER THAN EARLY CHILDHOOD I I 1 11I 7.F. OF THE CLASSROOM STAFF IN 7.A.,THE NUMBER WITH A CDA CREDENTIAL AS WELL AS A FOUR YEAR DEGREE IN EARLY CHILDHOOD EDUCATION(This is not the sum of 7.B.and 7.C.,but the number of classroom staff who hold BOTH a CDA Credential AND a degree in early childhood education.Do not include per- I I I 0 sons in 7.D.) 7.G. OF THE TOTAL NUMBER OF CLASSROOM STAFF in 7.A. NOT DIRECTLY IN- VOLVED IN CDA TRAINING, THE NUMBER DIRECTLY INVOLVED IN FORMAL TRAINING RELATED TO THEIR CLASSROOM ACTIVITIES DURING THIS OPERATING PERIOD (Formal training includes college, correspondence, or other accredited courses. It does not include preservice or in-service training.) ' I 11I l COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER,ZERO, OR NA a LEAVE NO ITEM BLANK 8. HOME VISITOR INFORMATION (For home-based models only. If you do not operate a home-based program, enter "NA." Include only home visitors who were with your Head Start program for more than half the time you conducted home visits.) S.A. NUMBER OF HOME VISITORS L I IN JA I B.B. OF THE HOME VISITORS IN B.A., THE NUMBER WITH ONLY THE CDA CRE- DENTIAL (Enter the number of home visitors who have only the Child Develop- ment Associate (CDA) Credential.) I I IN IA I B.C. OF THE HOME VISITORS. IN B.A., THE NUMBER WITH ONLY A FOUR YEAR DEGREE IN EARLY CHILDHOOD EDUCATION (Enter the number of home visitors with Bachelor or advanced degrees in early childhood education award- ed by an accredited college or university. Use same definition in instructions as was used for Item 7.) I.. I IND I 8.D. OF THE HOME VISITORS IN 8A., THE NUMBER WITH THE CDA CREDEN- TIAL AS WELL AS A DEGREE IN EARLY CHILDHOOD EDUCATION (This is not the sum of 8.8. and B.C., but the number of home visitors who hold BOTH a CDA Credential and a degree in early childhood education.) , I I IN IA B.E. OF THE HOME VISITORS IN 8A,THE NUMBER DIRECTLY INVOLVED IN CDA OR ANY OTHER FORMAL TRAINING RELATED TO THEIR RESPONSIBILITIES FOR WORKING WITH CHILDREN AND FAMILIES IN THE HOME (Formal train- ing includes college,correspondence or other accredited courses. It does not in- clude preservice or in-service training.) I I IN IA I 9. VOLUNTEER SERVICES INFORMATION 9A. THE TOTAL NUMBER OF PERSONS PROVIDING ANY VOLUNTEER SERVICES TO YOUR PROGRAM DURING THIS OPERATING PERIOD (Count all persons volunteering services, not just those reflected in 9.B., 9.C., and 9.D., below.) I _1 3 I8 13 I 9.B. THE NUMBER OF HEAD START PARENTS WHO HAVE PROVIDED VOLUNTEER • SERVICES (Include all volunteers whose children are current or former par- ticipants in Head Start. Legal guardians or primary care givers may be counted. Each parent volunteer should be counted only once even though that volunteer may have provided repeated services. This number cannot be larger than the number in Item 9A.) I 12 11 It I 9.C..NUMBER OF PERSONS FROM THE FOSTER GRANDPARENTS PROGRAM WHO PARTICIPATED IN YOUR PROGRAM FOR ANY LENGTH OF TIME DURING YOUR OPERATING PERIOD (If no one from the Foster Grandparents Program participated in your program, enter zero.) I I I I °I 9.D. NUMBER OF PERSONS FROM THE RETIRED SENIOR VOLUNTEERS PRO- GRAM(RSVP)WHO PARTICIPATED IN YOUR PROGRAM FOR ANY LENGTH OF TIME DURING YOUR OPERATING PERIOD (If no one from RSVP participated in your program, enter zero.) I I I I 0I 9.E. OF THE TOTAL NUMBER OF CLASSES (11.A.), THE NUMBER WITH AT LEAST ONE VOLUNTEER PRESENT MORE THAN HALF THE TIME IN WHICH CLASSES WERE IN SESSION. I I I fill 10. VOLUNTEER INFORMATION TOTAL NUMBER OF VOLUNTEER HOURS IN NOVEMBER AND APRIL(To com- pute, add the total number of hours volunteers worked in November and April. If your program did not operate in November or April, choose August (migrant pro- grams)or other months. Include volunteer hours outside the classroom,e.g., bus drivers or riders, office help, people who help prepare materials for class, etc. If you operate a home-based program only. put "NA".) I 12 1410 19I J COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO OR NA LEAVE NO ITEM BLANK 11. CLASSROOM INFORMATION 11.A. NUMBER OF CLASSES OPERATED(A class is a group cf c ildren who function as a single unit Classes which share space should be counted as separate classes if they function as separate units. For programs :Derating double ses- sions, count each session as a separate class. Do r.:_ count home-based classes.) I _ _I1_J 9a 11.B. AVERAGE NUMBER OF WEEKS PER YEAR CLASSES CPERATE (Include all weeks children are in class. Do not count scheduled vacaton periods as weeks of operation.) I I .13 L4I r 12. ENROLLMENT INFORMATION (See instructions.) 12A TOTAL. FUNDED ENROLLMENT (Funded enrollment means the number of children you have been funded to serve.) LI I 12.B. ACTUAL ENROLLMENT INCLUDING DROP-OUTS AND LATE ENROLLEES(Ac- tual enrollment refers to the total number of Head Start ciitdren served during your entire operating period regardless of funding source. It includes all children served for any length of time including drop-outs and late enrollees. This will include children who were enrolled but left the program before classes began, if these children or their families received any serti ores from Head Start such as medical screening, social services, or dental examinations. Refer to instructions for example.) I 13I 2 I2 I 12.B.1. ENROLLMENT BY AGE COMPOSITION (Include all dropouts and late enrollees. Use the age of the child as of October 1, 1934. For any child enrolled after October 1, 1984, use the age at the time of enrollment.) CLASSROOM HOME BASED 123.1.a_ 1YEAROLDANDYOUNGER I I IN LAI I I IN I AI 126.1.b. 2 YEARS OLD I I IN I AI I I IN I AI 128.1.c. 3YEARSOLD I I IN I AI I I IN I AI 12.6.1.d. 4 YEARS OLD I 12 16 I 8) I I IN AI 1213.1.e. 5 YEARS OLD I I 15 14I I I IN I AI 12B.1.f. 6 YEARS OLD AND OLDER I I IN I AI I I IN I AI 126.1.g. TOTAL OF 1213.1.a.-f. I _ 13 12 12 I I I IN I AI 12.B.1.h. TOTAL ACTUAL ENROLLMENT(This is the sum of 12.B.1.g.columns 1 &2,and must be the same 1 as Item 12.B.) 12.82. OF THE TOTAL ACTUAL ENROLLMENT, THE NUY.3ER OF CHILDREN WHO ARE ENROLLED IN HEAD START FOR THE SECOND YEAR. III 141 12.B.3 OF THE TOTAL ACTUAL ENROLLMENT, THE NUM ER OF CHILDREN WHO ARE ENROLLED IN HEAD START FOR THE iH;RD YEAR. Li I I 0I \ J COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA 5 LEAVE NO ITEM BLANK 12. ENROLLMENT INFORMATION (continued) 12.C. AVERAGE DAILY ATTENDANCE (See instructions for calculating these numbers.) Selected Month Funded Enrollment End of Month Average as of Selected Actual Daily Month Enrollment Attendance November (seelnstruc- I 1 21215 ! I 1 21414 I I 121 0 O tions) 12.D. ENROLLMENT BY TYPE OF PROGRAM OPERATED (1) (2) FUNDED ACTUAL ENROLLMENT ENROLLMENT 121.1.STANDARD HEAD START MODEL (A program which • operates 5 days a week and provides center-based ac- tivities to the same group of children.) 12.D.1.a. Full day enrollment I I IN IA J I I J NIA I - 12.0.1-b. Part day enrollment I 1 IN IA I I I I NIA I • 12.0.2. DOUI3LE SESSION (A program which serves two separate groups of children in one day,one in the morn- ing and one in the afternoon. It may operate less than 5 I I N IA I I I 1 N'J A days per week.) I I 12D.3. HOME-BASED MODEL (A program which uses the home as the central facility and focuses on the parents as the primary factor in the child's development.) I I I N I AI I I I NJ A J 12.D.4.VARIATIONS IN CENTER ATTENDANCE (A center- based program which serves children on a less than I 12I 7 i5 I I 13 I2 2 J five-day-per-week basis.) 12.03. LOCALLY DESIGNED OPTIONS (ACYF Headquarters approved options which have been specifically design- ed to meet the particular needs of the children and I I I N IA I I I IN I A families in their communities.) 12.0.6.TOTAL FUNDED ENROLLMENT (This is the sum of 12.D. Column (1), Funded Enrollment, and must be the same number shown in 12.A.) I I 21 7 15 I 12.D.7.TOTAL ACTUAL ENROLLMENT(This is the sum of 12.D. Column (2), Actual Enrollment, and must be the same number shown in 12.B.1.h. and shown in 12.B.) I 13 12 12 I COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA LEAVE NO ITEM BLANK 12. ENROLLMENT INFORMATION (continued) 12.E. NUMBER OF DROP-OUTS(Do not count as drop-outs children who dropped out during this operating period and later re-enrolled.) 12.E.1 OF THE TOTAL ACTUAL ENROLLMENT, THE NUMBER OF CHILDREN WHO WERE ENROLLED BUT DROPPED OUT BEFORE CLASSES BEGAN OR, FOR HOME-BASED PROGRAMS, BEFORE HOME VISITS BEGAN (NOTE:These are children included in Items 12.B and 12.D who received services from Head Start before dropping out.It does not include children who dropped out without receiving any Head Start services.The children entered here should not be entered in Items 12.E2. or 12.F. below.) I I [1_14 I 12.E2. OF THE TOTAL ACTUAL ENROLLMENT, THE NUMBER OF CHILDREN WHO DROPPED OUT AT ANY TIME AFTER CLASSES BEGAN OR, FOR HOME-BASED PROGRAMS, AFTER HOME VISITS BEGAN (Do not in- clude children entered in Item 12.E.1.) I I 13 j6 I • 12.E.3. TOTAL NUMBER OF DROP-OUTS (This is the sum of Items 12.E.1. and 12.E2.) Ltd 5 Io I 12.F. NUMBER OF CHILDREN WHO WERE IN CLASSES LESS THAN 3 MONTHS Count from the date the child began classes or home visits began for home- based programs. NOTE: Do not include children entered in Item 12.E.1.) I I I 1 I6 • COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA 7 LEAVE NO ITEM BLANK 13. RACIALIETHNIC COMPOSITION INFORMATION 13.A. ENROLLMENT BY RACIAL/ETHNIC COMPOSITION (Include all drop-outs and late enrollees for whom you have provided any service. Ethnic and racial terms refer to those used by the Equal Employment Opportunity Commission and the Office for Civil Rights,who do not allow additional categories such as"bi-racial" or "other'. It may be necessary to interpret these categories to fit specific populations or individuals.When in doubt about the ethnicity of a child, ask the parents.) 13A1.WHITE (Not of Hispanic origin—all persons having origins in any of the original peoples of Europe, North Africa, or the M..:)4le East.) 1 I OP ' 13A2. BLACK (Not of Hispanic origin—all persons having origins in any of the Black racial groups of Africa.) I. 1 I III 13.A.3_ HISPANIC (Spanish origin) _ I I2 12 (5 I 13.A.4.ASIAN OR PACIFIC ISLANDER (All persons having origins in any of the original peoples of the Far East,Southeast Asia, the Indian subcontinent or the Pacific Islands.) I 1 1 2 13.A5. AMERICAN INDIAN OR ALASKAN NATIVE (All persons having origins in any of the original peoples of North America.) 1 I I 11I I 13.A.6.TOTAL ACTUAL ENROLLMENT(This is the sum of 13.A.1. through 13.A.5. and should be the same number shown in 12.B.1.h.) 1 13 12 12 1 13.8. STAFF BY RACIAJETHNIC COMPOSITION (Include stagy who were with your program more than half of the time you were in operation._ Use the same defini- tions to determine ethnicity as used for enrollment.) 13.8.1. WHITE I I I 14 i 13.6.2. BLACK I- I I 10 13.83. HISPANIC 1 i 1 ? 16 I 13.6.4. ASIAN OR PACIFIC ISLANDER I I I 10 I 13.8.5.AMERICAN INDIAN OR ALASKAN NATIVE L I 1 I0 I 13.6.6.TOTAL STAFF(This is the sum of 13.8.1.through 13.8.5. and must be the same number shown in 6.A.3.) 1 I 1 2 10 I COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA 8 LEAVE NO ITEM BLANK 14. HEALTH SERVICES INFORMATION (Note that this information should be obtained from records of all the children served for any length of time during your operating period regardless of funding source. INCLUDE late enrollees and children who dropped out before or after classes began.) 14.A. MEDICAL SERVICES 14A.1. NUMBER OF ALL CHILDREN (INCLUDING THOSE ENROLLED IN MEDICAID/EPSDT)WHO HAVE COMPLETED MEDICAL SCREENING, IN- CLUDING ALL APPROPRIATE TESTS AND PHYSICAL EXAMINATIONS (Refer to instructions for list of required screenings. Re-enrolled children who were screened the preceding operating period through Head Start, and children screened prior to their enrollment in Head Start should also be counted if they have completed all required screenings.INCLUDE drop- outs and late enrollees if they have completed all required screenings. NOTE: Do not include children who are missing any of the required screenings. Do not include children under three years of age.) I 1 3 I 1 181 14A1.a. OF THOSE COMPLETING ALL SCREENINGS(INCLUDING THE PHYSICAL EXAMINATION), THE NUMBER OF CHILDREN DIAGNOSED AS NEEDING TREATMENT I I 12 I SI 14A1.b. OF THOSE DIAGNOSED AS NEEDING TREATMENT, THE . NUMBER OF CHILDREN WHO HAVE BEGUN, BUT NOT COM- PLETED, TREATMENT I I I 19I 14A1.c. OF THOSE DIAGNOSED AS NEEDING TREATMENT, .THE NUMBER OF CHILDREN WHO HAVE COMPLETED TREAT- MENT u 12 181 (NOTE:The sum of 14.A.1.b. + 14.A.1.c.cannot exceed the number in Item 14.A.1.a.) 14A2. NUMBER OF CHILDREN ENROLLED IN MEDICAID/EPSDT ("Medicaid/EPSDT enrolled" means that the child has been officially cer- tified as eligible for Medicaid or EPSDT paid services. It does not include children who are thought to be eligible but have not been officially cer- tified. Include children who were enrolled in Medicaid or EPSDT for any length of time during this operating period. NOTE: Medicaid/EPSDT may be known in your state by another name such as the Child Health Assurance Program (CHAP), Child Health Disability Prevention Program (CHDP), MEDICHECK or MEDI-CAL) I 111 1 15 I 14.A.2.a. OF THE NUMBER ENROLLED IN MEDICAID/EPSDT, THE NUMBER OF CHILDREN WHO HAVE RECEIVED ANY MEDICAL SCREENING SERVICES (INCLUDING THE PHYSICAL EXAMINATION)PAID FOR BY MEDICAID OR EPSDT I 111 1_I 5 I 14.A.2.b. OF THOSE ENROLLED IN MEDICAID/EPSDT.THE NUMBER OF CHILDREN DIAGNOSED AS NEEDING TREATMENT (whether or not screening services were paid for by Medicaid/EPSDT) L:1 I 1 10 I 14.A.2.c. OF THOSE ENROLLED IN MEDICAIDIEPSDTAND DIAGNOSED AS NEEDING TREATMENT,THE NUMBER OF CHILDREN WHO HAVE RECEIVED ANY MEDICAL TREATMENT SERVICES PAID FOR BY MEDICAID/EPSDT I I 11 IO I \ / COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA 9 LEAVE NO ITEM BLANK 14. HEALTH SERVICES INFORMATION (continued) 14.B. DENTAL SERVICES 14.B.1. NUMBER OF ALL CHILDREN (INCLUDING THOSE ENROLLED IN MEDICAID/EPSDT) WHO HAVE COMPLETED A PROFESSIONAL DEN- TAL EXAMINATION DURING YOUR OPERATING PERIOD (INCLUDE late enrollees and children who dropped out before or after classes started if these children completed a dental examination.Count only those children who received a professional dental examination during this operating period. A professional dental examination is one done by a dentist.) ( 12 17 15 I 14.B.1.a. OF THOSE EXAMINED, THE NUMBER OF CHILDREN DIAGNOSED AS NEEDING TREATMENT (Treatment includes restoration, pulp therapy or extraction. it does not include fluoride application or cleaning.) t I 1 JO 19 14.B.1.b. OF THOSE DIAGNOSED AS NEEDING TREATMENT, THE NUMBER OF CHILDREN WHO HAVE BEGUN, BUT NOT COM- PLETED,TREATMENT(Treatment does not include fluoride ap- plication or cleaning.) 1 I I 18j 14.6.1.c. OF THOSE DIAGNOSED AS NEEDING TREATMENT, THE UER OF CHILDREN WHO HAVE COMPLETED TREAT- MENT I l 10 I 1 (NOTE:The sum of 14.B.1.b. + 14.B.1.c.cannot exceed the number In Item 14.B.1.a.) 14.82. DENTAL SERVICES FOR MEDICAID/EPSDT ENROLLEES (NOTE: These children should have been included in Item 14.8.1. through 14.B.1.c.) 14.B.2.a. OF THE CHILDREN ENROLLED IN MEDICAID/EPSDT, THE NUMBER WHO HAVE RECEIVED DENTAL EXAMINATIONS PAID FOR BY MEDICAID/EPSDT L I 1 [ 1 5I 14.6.2.b. OF THE CHILDREN ENROLLED IN MEDICAID/EPSDT, THE NUMBER DIAGNOSED AS NEEDING TREATMENT, WHETHER OR NOT DENTAL EXAMS WERE PAID FOR BY MEDICAID/EPSDT (Treatment includes restoration, pulp therapy,or extraction. It does not include fluoride application or 12 14I cleaning.) 14.8.2.c. OF THE CHILDREN ENROLLED IN MEDICAID/EPSDT AND DIAGNOSED AS NEEDING TREATMENT, THE NUMBER OF CHILDREN WHO HAVE RECEIVED ANY DENTAL TREATMENT PAID FOR BY MEDICAID/EPSDT (Treatment does not include fluoride application or cleaning.) 1 I 121 41 14.C. IMMUNIZATION SERVICES (Head Start requires the following immunizations: 4 doses of DPI (Diphtheria, Pertussis, Tetanus), 3 doses of Polio, and one dose each of Measles, Rubella, and Mumps. Head Start requires these immunizations even where state law does not. See instructions on immunization policy. NOTE: Count each child only once. The sum of 14.C.1.-3. cannot exceed the number in Item 12.B.1.h.) 14.C.1. NUMBER OF CHILDREN WHO HAVE COMPLETED REQUIRED IM- MUNIZATIONS PRIOR TO STARTING YOUR OPERATING PERIOD(Report a child here only if that child has completed 4 doses of DPT, 3 doses of Polio and that same child has also received one dose each of Measles, Rubella, and Mumps prior to the start of your operating period. Include Head Start re-enrollees who completed immunizations during the preceding operating period and newly enrolled children who completed immunizations prior to entry into Head Start. Include drop-outs and late enrollees. NOTE: Do not include children who are current or up-to-date if they have not received all the required doses.) 1_12_11_1.5J COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA LEAVE NO ITEM BLANK • 14. HEALTH SERVICES INFORMATION (continued) 14.C. IMMUNIZATION SERVICES (continued) 14.C2. OF THOSE CHILDREN WHO HAD NOT COMPLETED ALL REQUIRED IM- MUNIZATIONS PRIOR TO THE START OF YOUR OPERATING PERIOD, THE NUMBER WHO COMPLETED ALL REQUIRED IMMUNIZATIONS BY THE END OF YOUR OPERATING PERIOD (Include children who com- pleted all required immunizations during your operating period; i.e., had no previous immunizations plus children who had some immunizations prior to the start of your operating period and received the remaining re- quired immunizations during this operating period. Include drop-outs and late enrollees. Do not include children entered in 14.0.1. Do not include children who are current or up-to-date if they have not received all required doses. NOTE: Report a child here only if that child has completed 4 doses of DPT, 3 doses of Polio, and that same child has completed one dose each of Measles, Rubella, and Mumps.) Li 5 13 1 14.C.3. NUMBER OF CHILDREN WHO HAVE NOT COMPLETED ALL REQUIRED IMMUNIZATIONS, BUT ARE CURRENT OR UP-TO-DATE IN THEIR IM- MUNIZATIONS(Do not include children entered in Items 14.C.1.or 14.C.2.) I I I 14 I l 15. SOCIAL SERVICES INFORMATION ((his refers to families of children enrolled in Head Start during this operating period. Families of children who have dropped out are also to be included.See instructions for fur- ther definitions and examples.) 15.A. TOTAL NUMBER OF HEAD START FAMILIES (Count families, not children. Families with more than one child enrolled should only be counted once. This cannot be larger than the number in Item 12.6.1.h.) I 13 12 11 1 15.B. OF THE TOTAL NUMBER OF HEAD START FAMILIES, THE NUMBER OF FAMILIES WHO ARE `SINGLE PARENT FAMILIES L.11 15 19 1 15.C. OF THE TOTAL NUMBER OF HEAD START FAMILIES, THE NUMBER OF FAMILIES FOR WHOM YOU HAVE COMPLETED A FAMILY NEEDS ASSESS- MENT (This cannot be larger than the number in Item 15.A.) 1 13 1 2 11 -I 15.D. OF THE TOTAL NUMBER OF FAMILIES, THE NUMBER OF FAMILIES IDEN- TIFIED AS NEEDING SOCIAL SERVICES(NOTE:This includes families who have been identified as needing services at any time during the operating period whether or not a needs assessment has been completed.This cannot exceed the number in Item 15.A.) I II 19 (4 1 15.E. OF THOSE IDENTIFIED AS NEEDING SOCIAL SERVICES: (NOTE: Count each family only once.) 15.E.1. NUMBER OF FAMILIES ONLY PROVIDED SOCIAL SERVICES DIRECTLY FROM HEAD START(RECEIVED NO REFERRALS to other agencies.) II I l 14 I 15.E.2. NUMBER OF FAMILIES ONLY REFERRED BY HEAD Si ART (RECEIVED NO DIRECT SOCIAL SERVICES from Head Start.) I I1 1. 613 1 15.E.3. NUMBER OF FAMILIES WHO RECEIVED SOCIAL SERVICES DIRECTLY FROM HEAD START AND WHO ALSO WERE REFERRED BY HEAD START TO OTHER AGENCIES (NOTE: Do not include here any family reported in your response to Items 15.E.1. or 15.E.2. Report a family here only if that family has received a Head Start social service such as counseling, and that same family has also been referred by Head Start to another agency.) I I I I.17 I 15.E.4. TOTAL NUMBER OF FAMILIES PROVIDED SOCIAL SERVICES (This is the sum of Items 15.E.1. through 15.E.3. and cannot be larger than the number in Item 15.D.) I 11 19 14 I • COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, OR NA 11 LEAVE NO ITEM BLANK SECTION S. HANDICAPPED SERVICES COMPLETE ITEMS 16-23 WHETHER OR NOT YOUR PROGRAM HAS ENROLLED ANY HANDICAPPED CHILDREN 16. Number of handicapped children who were located by you,or referred to you,that you were not able to enroll for the following reasons (Count only the primary reason for not being able to enroll each child. If all han- dicapped children were enrolled, enter zero (0) in each space.) 16A. Did not meet income guidelines I I I 12 I 16.B. No available openings I _ I I 19 16.C. Other agencies serve these children • 1 • Li I_ 14 16.D. Handicap too severe; Head Start is not the most appropriate placement `I I I lo I 16.E. Child's parents refused I I I 10 I 16.F. Lack of adequate transportation I I I 10 1 16.G. Did not fit age requirements I I I J1 I 16.H. Other (Specify) I I I N IA I 17. Which of the following agreements with other agencies does your program have regarding services to han- dicapped children?(If program is a delegate agency,the agreement may be directly with the delegate agency or may be with the grantee that includes the delegate agency. If the delegate agency does not have this infor- mation, please contact the grantee. Check (✓) ALL that apply.) 17A. Written or informal agreement with local education agency regarding services to be provided to handicapped children. 17.B. Written or informal agreement with other agencies regarding services to be pro- vided to handicapped children. COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (✓), OR NA 17 LEAVE NO ITEM BLANK 18. Does a Handicaped Services Coordinator work full-time or part-time for your program as Handicapped Ser- vices Coordinator?(If your program has more than one Handicapped Services Coordinator,and one or more works full-time, while the other(s) works part-time as Handicapped Services Coordinators, check both boxes.) 18.1 Yes, Full-time 18.2. Yes, Part-time LJ 18.3. (FOR DELEGATE AGENCIES ONLY) No, there is no Handicapped Services Coor- dinator specifically for this program, but there is one at the grantee level who serves (---'I this program. L 1 18.4. No, there is no Handicapped Services Coordinator [I] l 19. Which of the following degrees or licenses are held by the Handicapped Services Coordinator(s)in your pro- gram (as identified in question 18.)? Check (✓)all that apply. 19.1. Early childhood/special education 19.2. Special education L..- 19.3. Speech pathologyfaudiology �l Fl19.4. Psychology 19.5. Other(Specify) Pre-School Education LX_J 19.6. No degree or license • 20. Number of volunteers, including parents,working in your program primarily or exclusively providing special assistance to handicapped children (If none, enter zero (0).) I I I 16 I \ • 21. Number of persons provided to your program by an outside agency(other than Head Start • funding source) for the primary or exclusive purpose of providing special assistance to handicapped children (If none, enter zero (0).) I I 17 15 • 22. Number of children not professionally diagnosed but believed to be handicapped and I I 19 referred for diagnosis. COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (✓), OR NA LEAVE NO ITEM BLANK 23. Were any professionally diagnosed handicapped children enrolled in your program at any time during the operating period? (Check (r) the ONE that applies.) 23.A. Yes (Continue with Item 24.) X 23.B. No,there were no professionally diagnosed children enrolled. CA a number believed '' ii to be handicapped have been referred for diagnosis (Skip to !ter 37.) hl 23.C. No, there were no professionally diagnosed children and none were referred(Skip to Item 37.) J COMPLETE ITEMS 2436 ONLY IF YOUR PROGRAM HAS ENROLLED CHILDREN PRC;ESSIONALLY DIAGNOSED AS HANDICAPPED. 24. Number of children professionally diagnosed as handicapped durng the following time periods: 24.A. Prior to enrollment for this operating year (Children in their second or third year of Head Start who were diagnosed as handicapped in a pre. cus operating period . should be counted here.) I I I 1 18 I 24.8. Between time of enrollment and January 31, 1985. I I 13J 6 I 24.C. Between February 1, 1935 and end of operating period I I 12I 1 24.D. Total professionally diagnosed (This is the sum of Items 24X-C.) I I I 5 I 24.E. Of the total actual enrollment of handicapped children (2=.D.i, the number who dropped out at any time during this operating period. (Do pct count as drop-outs children who dropped out during this operating period and later re-enrolled.) I I I 13 I l 1 25. Check below which steps you have taken this year to enroll and serre more severely handicapped children (Check (4 ALL that apply.) 25.A. Specific outreach and recruitment procedures aimed at the severely handicapped 11 25.8. Change(s) in recruitment and enrollment criteria X 25.C. Orientation sessions for local diagnosticians, providing spec'al materials, etc. X 25.D. Coordination with other agencies serving severely har.dF__ rd children (e.g. outreach and recruitment, identification and referral) X 25.E. Sharing services with other agencies serving severely hanH:- -Ad children (e.g. joint placement. transportation, joint funding) I X 1 25.F. Other(Specify)._ N/A p 25.G. No steps taken. Reason N/A COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (r), OR NA 14 LEAVE NO ITEM BLANK 26. Number of children, for home-based and center-based options, who have been professionally diagnosed as handicapped. by the following age groups: (Report age of child as of October 1, 1984. For any child enrolled after October 1, 1984, use the age at the time of enrollment.) 1 2 Home-based Center-based 26.A. 1 YEAR OLD AND YOUNGER I I IN A I I NJ AI 26.B. 2 YEARS OLD I I IN IAI LI NI AI 26.C. 3 YEARS OLD I I IN LA I LA I NIA i 26.D. 4 YEARS OLD I I IN I AI L ' 161 71 26.E. 5 YEARS OLD N A I I I 18i 26.F. 6 YEARS OLD AND OLDER I I- IN I Ai I I I NJ AI 26.G. TOTAL NUMBER OF CHILDREN (The sum of Columns 1 +2 in 26.G. must be the same as Item 24.D.) I I I I I L_l 1 7I 5.1 l � 27. Number of classes operated by your Head Start program with at least one professionally diagnosed handicapped child enrolled at any time during this operating period (Do not count home-based classes.) I. � _ L 1� 28. Number of professionally diagnosed handicapped children enrolled in a home-based op- tion who have been brought together for a group activity at least once per month. I I. I NI A I 29. Number of children professionally diagnosed as handicapped who were referred for enrollment €n your pro- gram_by agencies or individuals outside of Head Start and were: 29.A. Referred already professionally diagnosed I I ill 8] 29.B. Referred not already professionally diagnosed and subsequently professionally diagnosed after enrollment in Head Start J. 17I 29.C. Total (This is the sum of Items 29.k and 29.B.) I I 17 I J COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (.-), OR NA 15 ... LEAVE NO ITEM BLANK ..... NOTE:, Before completing Item 30, refer to Diagnostic Criteria (pp vi-vii) 30. In the chart below please enter the number of children enrolled during this operating period whose primary or most disabling handicap has been professionally diagnosed as one of the following. (In categories E,F, G and J, enter the total number of children for each of the subcategories specified, sum them and enter the total for the entire category in the space provided at the far right. If there are no children with that particular condition in your program, enter a zero (0).) Total Number Children with These Primary Handicapping Conditions: of Children 30.A. BLINDNESS Total I I In I 30.B. VISUAL IMPAIRMENT Total I J 13 I 30.C. DEAFNESS Total I I h I 30.D. HEARING IMPAIRMENT Total I I 13 I 30.E. PHYSICAL HANDICAP 1. Cerebral Palsy _ I I I a I 6. Bone Defect I I 101 2. Absence of Limb I I IBI 7. Congenital Anomalies II I QJ 3. Deformed Limb I I In I 8. Spina Bifida I I I 0J 4. Arthritis I I I n I 9. Severe Scoliosis I I I o I 5. Oro/Facial Malformations I I 1.,p I 10. Other (Please specify.) : I I 111 Brain tumor-Medula B l a l l o m a Total I I 181 30.F. SPEECH IMPAIRMENT I I 111 1. Severe Stuttering 4. Voice Disorders Clinicians per I 110- 1 g 2. Severe Articulation 5. Expressive or Receptive Difficulties I 11 10 I Language Disorders' 1 13 14I 3. Cleft Palate, Cleft Lip I I 0 I 6. Other. (Please specify.) I I 101 Total I I4 15I 30.G. HEALTH IMPAIRMENT2 I I I 0I 1. Epilepsy/Convulsive I I I1 1 5. Diabetes Disorders 6. Neurological Disorders I I I II 2. Respirator/ Disorders ( I I a I 7. Severe Allergies I I 161 3. Blood Disorders (e.g., 8. Autism I I 101 sickle cell disease, hemophilia, leukemia) I I 11 1 9. Other (Please specify) I I 101 4. Heart/Cardiac Disorders I I 12 I Total I 11 11I 30.H. MENTAL RETARDATION Total I I I Total I I I ol 30.1. SERIOUS EMOTIONAL DISTURBANCE I DO NOT include children. for .nc.:. English is,or would be,a second language unless tiny clearly have this impairment in their primary language as well. 2.Autism has been moveC from Ser Ie:s Emotional Disturbance to Health impairment. COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER,ZERO,OR NA 16 LEAVE NO ITEM BLANK 30. PROFESSIONALLY DIAGNOSED HANDICAPPED CONDITIONS (continued) 30.J. SPECIFIC LEARNING DISABILITIES 5. Motor Handicaps (gross, 1. Perceptual Handicaps I I I 21 fine, visual motor deficiency) I I 131 2. Minimal Brain Dysfunction I I I 01 6. Sequencing and Memory (auditory and visual) Problems I I 01 3. Dyslexia 101 l 7. Hyperkinetic Behavior I I I 01 4. Developmental Aphasia I I I 8. Other (Please specify.) I I 15I Color Blindness Total h I 1 1 01 30.K. TOTAL NUMBER OF CHILDREN PROFESSIONALLY DIAGNOSED AS • HANDICAPPED (This is the sum of 30.A.through 30.J. and must equal the total in Item 24.D.) Total 1 I p L5 I COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO,(4, OR NA 17 LEAVE NO ITEM BLANK - - 31. THIS ITEM REFERS TO THOSE CHILDREN REPORTED IN ITEM 30 WHO HAVE ONE OR MORE OTHER HANDICAPPING CONDITIONS AND APPLIES TO MULTIPLE-HANDICAPPED CHILDREN ONLY (If none, enter zeros in categories A-J.) First,by primary handicapping condition,indicate below the number of children professionally diagnosed as handicapped who also have one or more OTHER professionally diagnosed hanicapping conditions. (Enter these numbers immediately to the right of categories A-J, according to the primary handicapping condition of each child. If there are no children in a particular category, enter a zero (0).) Next, for the children in each category, record the number of their OTHER handicapping conditions which have been professionally diagnosed. (Enter a zero whenever there is no OTHER handicapping condition.) (For example, next to category A, record the number of children who, in addition to their primary handicap- ping condition of blindness, nave one or more OTHER handicapping conditions. In the row of boxes to the right(column numbers 1-10),record the number of OTHER handicapping conditions for these children.In this case, the first two boxes are shaded, meaning no numbers are entered there. Depending on the number of OTHER handicapping conditions each child has, the sum of the numbers in the row of boxes will be the same or larger than the number entered in category A.) Number of OTHER Handicapping Conditions 1 2 3 4 -5 6 7 8 9 10 Number ofChikfren with OTHER w w �� a _� _t �•a �za ozF Handicapping Conditions,According to z z Zr.", g 4 o Q r-¢ <cc z o rc LL f Their Primary Handicapping Condition z N w w >-Z a g w g i ©z y a w�' is >/_/ O 2- a2 CO.... X_. .tea t]wo NCO 31.A. BLINDNESS - I I I a I %/��.-.��®■ 31.6. VISUAL IMPAIRMENT I I 131 31.C. DEAFNESS I I I l I .. � 1 31.D. HEARING IMPAIRMENT I 1 13 I /. /. 3 �. 31.E. PHYSICAL HANDICAP I I III •••��•-•�® 31.F. SPEECH IMPAIRMENT I 14 15 I 31.G. HEALTH IMPAIRMENT I I1 I a i .-..�. ��. 31.H. MENTAL RETARDATION I. I I 0 I 31.1. SERIOUS EMOTIONAL I I I a IDISTURBANCE •�••••� � 31.J. SPECIFIC LEARNING I 11 I 0 I ■...-� DISABILITIES J COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER,ZERO,U-), OR NA 18 LEAVE NO ITEM BLANK 32. For those children in your program who have been professionally diagnosed as handicapped, indicate below the number who, according to the IEP or the IPP', require special education or related services at each of the following levels:(Assign each child to a category, but to only one category.The total sntered in Column 4 for each primary condition must be the same as that entered in Item 30. for the same condition. If there are no children with a particular condition in your program, enter zero (0). Refer to instructions for definitions of levels of special education or related services required.) Number Who Require: 1 2 3 4 Almost Total?lumber of Little or Some Fair Amount of Constant Ci firer; Children With These Special Special Special Requiring Primary Conditions: Education or Education or Education or Services for Related Related Related Each Primary Services Services Services Condition 32.A. BLINDNESS 1 1 1 1 + 1 I l 1 + 1 J L I = 1 I 101 32.B. VISUAL IMPAIRMENT I I 13 1 + 1 I 1 1 + 1- I I I I 1 _1 3 1 • 32.C. DEAFNESS 1 1_ 1_ 1 + 1 I 11 + 1 1 111 ., I 1 r I I 1 1 1 32.D. HEARING IMPAIRMENT I I I 1 + 1 1 131 + 1 1 1 I = t 13 J ` 32.E. PHYSICAL HANDICAP I I I. 1 + 1 I 1 1 i + 1 J I I I I �l I 32.F. SPEECH IMPAIRMENT I I I 1 + 1 1 I I Hi 1 4 1 5 1 = 1 1 4 I . 5I • • 32.G. HEALTH IMPAIRMENT I I 16 1 + 1 I 1 5 1 + I I I l = 1 1 1 1 1 1 32.H. MENTAL RETARDATION I I I 1 + 1 I I 1 + 1 I I 1 = 1 I I () I 32.1. SERIOUS EMOTIONAL DISTURBANCE I I I I + I I 1 1 1 + 1 I I 1 = 1 I 11 32.J. SPECIFIC LEARNING DISABILITIES I I I I + I I I I + I 1 11.0 1 = 1 Ii 10 I 32.K. TOTAL FOR ALL PRIMARY HANDICAPPING CONDITIONS (Sum the entries in each column and then across row K The total in 24 K4 must equal the total in Item I I 13 I + I I 1 I 0 I + I 15 16 I = 1 I 117 1 5I 'IEP Refers to the Individual Education Plan and IPP refers to the Individual Pro- gram Plan. COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER,ZERO, (✓), OR NA LEAVE NO ITEM BLANK 33. Of those children in your program who have been professionally diagnosed as handicapped,indicate below the number who, because of their handicapping condition, received special education or related services from BOTH Head Start and other agencies, Head Start staff ONLY, other agencies ONLY, and the number who received no special education or related services as required. (The total entered in column 5 for each primary condition must be the same as that entered in Item 30 for the same condition.If there are no children with a particular condition in your program, enter zero (0).) Number Who Received Special Services from: 1 2 3 4 5 Number Yob'Number Who of Children Children With These Both Head Received No Receiving Primary Coraiicrs Start and Other Special Services for Other Head Start Agencies Services As Efl Primary Agencies Staff Only Only Required Cs edition 33.A. BLINDNESS I 1 I 1 + I I I • t + 1 I I 1 + 1 I 1 1 = 1 I 1 0 1 33.B. VISUALIMPAIRMENT I I 1_ 1 + 1 11 31 + I I I _ 1 + l I I I = L I 131 33.C. DEAFNESS 1 1 11 1 + 1 I 11 + 1 I 11 + i I - 1 1 = 11 1 I1I 33.D. HEARING IMPAIRMENT 11 13 1 + I I I 1 + 1 1 _. 1 1 + 1 1 1 1 - 1 1 1 3 1 33.E. PHYSICAL HANDICAP I I 11 1 + 1 I I 1 + 1 I I 1 + 1 1 1 1 = 1 I 11 I 33.F. SPEECH IMPAIRMENT I 1 415 1 + I I I I - I I I 1 + 1 I 1 1 = 1 14 15i 1 33.G. HEALTH IMPAIRMENT I I Is 1 + 1 I I 61 + 1 1 I 1 + 1 I 1 J = 1 1 1 1 1 1 33.H. MENTAL RETARDATION 1 1 1 1 + 1 1 1 1 + 1 I I 1 + 1 1 1 1 = 1 11 01 33.1. SERIOUS EMOTIONAL DISTURBANCE 1 I 111 + 1 I l l + l I I 1 + 1 I I 1 = 1 1 1 iI 33.J. SPECIFIC LEAP,NiNG DISABILITIES I la 1O 1 - I I I 14 I I 1 + 1 11 1 = 1 1 1 1 0 1 33.K. TOTAL FOR ALL P71MkRY HANDICAPPING CONDI- TIONS(Sum the entries in each column and then across row K.The total in IC5 must equal the total in Item 24.D.) I 1 6 1 6 1 + 1 1 19 1 + 1 I I 1 + 1 1 I 1 = 1 I 17151 COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (✓), OR NA LEAVE NO ITEM BLANK l 34. For children professionally diagnosed as handicapped, check the types of special education or related services which they received during this operating 1 2 period from HEAD START STAFF (Column 1) and/or from OTHER AGENCIES From Head From Other (Column 2). (Check (.-) ALL that apply.) Start Staff Agencies 34.A. Individual teaching techniques �Xeg 34.8. Special teaching equipment, such as large print books, special literature, materials 0 la 34.C. Psychotherapy., counseling, behavior management U 34.D. Physical therapy, physiotherapy 0 u 34.E. Speech therapy, language stimulation 34.F. Occupational therapy 34.G. Special equipment for children, such as glasses, special shoes, crut- ches, etc. 0 [r.1 34.H. Education in diet, food, nutrition, health 34.1. Transportation 0 34.J. Family or parental counseling XC� 34.K. Medical treatment 34.L Medical or psychological diagnosis, evaluation or testing L 34.M. Assistance in obtaining special services included in the IEP (IPP) IX I• [� 34.N. Other services (Specify) N/A ❑ 0 34.O. None of the above ❑ Q 35. Number of parents of children professionally diagnosed as handicapped who have received special services from Head Start.(Count individual parents.Do not count parents who received only those services which are normally provided to all parents in your program, i.e., social services, parent involvement. If none, enter zero (0).) I I 1 181 COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (r), OR NA 21 LEAVE NO ITEM BLANK 36. Of those parents reported in Item 35 indicate the specific type(s) of special ser- vices these parents have received or are receiving. (Check (r) ALL that apply.) 36.A. Counseling I] 36.B. Literature or special teaching materials Ell El 36.C. Referrals to other agencies 36.D. Inservice meetings, conferences with technical staff [XIX 36.E. Special classes (therapy instruction, etc.) 36.F. Medical assistance in securing medical services O 36.G. Transportation Ell 36.H. Workshops to orient parents on school services and their rights under P.L 94-142. 36.1. Visits to home, hospitals, etc. 36.J. Parent meetings 36.K. Other(Specify)- 37. NAME OF PERSON(S) TO CONTACT IF ADDITIONAL INFORMATION REGARDING EACH PART OF THIS FORM IS NEEDED: (Provide telephone number where persons can be reached May 15-August 30, 1985.) A. Section on Program Services: (303) 686-2319 Dorothy Escarnilla Family Serv . /Parent INV( 303 ) 356-,0600 NAME TITLE TELEPHONE B. Section on Handicapped Services: (303) 330-9265 Lois Frank Special Needs ( 303 ) 356-0600 NAME TITLE TELEPHONE COMPLETE ALL ITEMS WITH APPROPRIATE NUMBER, ZERO, (✓), OR NA 38. NAME AND TITLE OF APPROVING OFFICIAL (Agency Director or other individual responsible for certifying that this form is the agency's authorized response.) Juanita Santana Head Start Director (303 ) 356-0600 NAME TITLE DATE COMMENTS: • • 23 Hello