Does this Does this staff work staff work in a Current with classroom Care Level Earnings Level of school that receives of (Child # Hours Award aged funding Education & Career Classroom Position Date of Care Worked children? through Head Amount Major Employee Name Lattice Title Hire (INF, YOT, Annual Per Yes/No Start, Pre-K Requested Attained (as Level OLT, PRE, and, if Counts or Salary & Week it appears on YSA, OSA or yes, list Early Bonuses) diploma) MXD) number Intervention? of hour (please per week specify) BA in Human Example: Jane Doe OO 3/2/2000 MXD $15,000 40 CL5 No No $3,605 Development $ $ $ $ $
Employee Name Position Title Date of Hire Care Level of Classroom (INF, YOT, OLT, PRE, YSA, OSA or MXD) Earnings (Child Care Annual Salary & Bonuses) # Hours Worked Per Week Career Lattice Level Current Level of Education & Major Attained (as it appears on diploma) Does this staff work with school aged children? Yes/No and, if yes, list number of hour per week Does this staff work in a classroom that receives funding through Head Start, Pre-K Counts or Early Intervention? (please specify) Award Amount Requested Example: Jane Doe OO 3/2/2000 MXD $15,000 40 CL5 BA in Human Development No No $3,605 $ $ $ $ $