Single Parent 30 All children from Indian and non-Indian families living on the Yurok reservation 60 that meet low-income guidelines: ERSEA Key Indicator #2 All children from income-eligible Indian families native to the reservation Yurok 40 but living in non-reservation areas approved as part of the Yurok Tribe's HS/EHS service area: ERSEA Key Indicator #2 Living within the sites community Service Area 20 Home Base Enrollee 20 OVER INCOME High Risk: social services referral, CPS safety plan, teen parent, parent 25 incarcerated/rehabilitation center Single Parent 25 Yurok Tribal Member /Descendant with proof of enrollment of self or ancestor. 50 Other Federally Recognized Tribal Member/Descendant with proof of enrollment of self or 30 ancestor. Living site community Service Area: 15 Home Base Enrollee 10 Total If there is a tie with in the ranking criteria the slot will be given to the lowest income. Accepted On waiting list ERSEA Monitor initial: ______________ ________________________________________________ ______________________ Site Family Service Coordinator Date
30 Single Parent 60 All children from Indian and non-Indian families living on the Yurok reservation that meet low-income guidelines: ERSEA Key Indicator #2 40 All children from income-eligible Indian families native to the Yurok reservation but living in non-reservation areas approved as part of the Yurok Tribe's HS/EHS service area: ERSEA Key Indicator #2 20 Living within the sites community Service Area 20 Home Base Enrollee OVER INCOME 25 High Risk: social services referral, CPS safety plan, teen parent, parent incarcerated/rehabilitation center 25 Single Parent 50 Yurok Tribal Member /Descendant with proof of enrollment of self or ancestor. 30 Other Federally Recognized Tribal Member/Descendant with proof of enrollment of self or ancestor. 15 Living site community Service Area: 10 Home Base Enrollee Total If there is a tie with in the ranking criteria the slot will be given to the lowest income. Accepted On waiting list ERSEA Monitor initial: ______________ ________________________________________________ ______________________ Site Family Service Coordinator Date