ECD / HSAC – FORM / TEMPLATE DATE/ POSTED HSAC Committee Membership Form 09/07/06   EDUCATION – FORM / TEMPLATE DATE/ POSTED 2009 Kohl McCormick Early Childhood Teaching Awards 10/10/08 Download Nomination Form | Online Nomination   DISABILITIES SERVICES – FORM / TEMPLATE DATE/ POSTED Bus Stop Location Change Request: English | Spanish 09/08/08 Joint Screening Referral | Consent Form 09/05/08 “Look What I Can Do” Order Form 09/11/08 Paraprofessional Application Template 07/08/08 Process | Role Rights and Responsibilities of Parents of Children with Disabilities 09/04/08 Specialized Health Care: Forms | Instructions 04/23/08 SRT Form – Word Template 10/24/07   DENTAL – FORM / TEMPLATE DATE POSTED 2008 Cooperative Dental Services Agreement – Community Provider 09/11/08 CYS Form 2615 – Child’s Dental Record 08/29/06     MEDICAL – FORM / TEMPLATE DATE POSTED 2008 Cooperative Medical Services Agreement – CDPH Clinics 09/11/08 2008 Cooperative Medical Services Agreement – Community Provider 09/11/08 Certificate of Child Health Examination – IDHS 06/19/07 Download English Version | Spanish Version Certificate of Infant/Toddler Examination – IDPH 06/19/07 CYS Form 2614 – Child’s Health Record 08/29/06 TB Provider Letter 08/29/06     MENTAL HEALTH – FORM / TEMPLATE DATE POSTED 2008 Cooperative Agreement for Mental Health Services 09/11/08 CYS Form 1115 – Report on Mental Health Services 08/19/07 CYS Form 1388 – Support Services Verification 08/19/07 CYS Form 2659A – Mental Health Activity Record 08/19/07 CYS Form 2659B – Parent Mental Health Activity Record 08/19/07 CYS Form 2954 – Consent for Mental Health Individual Observation 01/31/07     NUTRITION – FORM / TEMPLATE DATE POSTED Child and Adult Care Food Program – Infant Acceptance / Waiver Form 03/20/06 CYS Form 3171 – EHS/CC Child/Family Nutrition Needs Assessment, I/T (Word Template) 09/18/07 HS / EHS – Cooperative Agreement for Nutrition Services 11/01/07   PROGRAM GOVERNANCE – FORM / TEMPLATE DATE/ POSTED Parent Committee | Policy Committee Committee Tracking Form 09/26/08   FORM / TEMPLATE  DATE POSTED 2007 Delegate Agency Self Assessment Reporting Instrument 02/21/07 FY 2007 PRISM Protocol 01/18/07 Get Waterwise – Powerpoint Presentation 07/05/06 HS Program Information Report (PIR) 2008 07/16/08 Quality Books Order Form 01/29/07 Slot Reallocation Packet Template – Word 01/25/07 SPL Request Form | Instructions 06/20/08