Spokane Head Start /EHS ERSEA PRIORITY POINT CHECKLIST 2017-2018 INCOME ELIGIBILITY (Choose ONE) POINTS AWARDED Categorically eligible (at or below 100% FPL, TANF, Supplemental Security 100 Income-SSI, Foster, Homeless) 50 101-130% FPL 0 Over 130% FPL AGE ELIGIBILITY (Choose ONE) POINTS AWARDED HS Preschool Programs 100 Age 4 by August 31 50 Age 3 by August 31 0 Age 3 August 31 and before December 31 - 200 Age 3 after December 31 EHS Infant/Toddler Programs 20 Age 1 or 2 by August 31 30 Prenatal - 1 year old SPECIAL NEEDS POINTS AWARDED 200 Homeless 2 Diagnosed disabilities (has an IEP or IFSP) 10 Agency referral OTHER FACTORS POINTS AWARDED Homeless within the last year 2 Teen parent 2 Domestic violence 2 Parental substance abuse issues (or in recovery) 2 Incarcerated parent 2 Parental disability (developmental, physical, mental health) 2 Single parent 2 CPS involved 2 English language learners 2 Student at Community Colleges of Spokane (at least 6 credits or ABE/ESL) 5 Working parents 5 Sibling of currently enrolled child 10 Other (examples: divorce / separation or death within past 12 months, family 2 trauma, i.e., house fire, major illness, victim of violent crime, etc.) Total Points 0 SITE-SPECIFIC POINTS AWARDED POINTS AWARDED Staff Child’s name initials
Spokane Head Start /EHS ERSEA PRIORITY POINT CHECKLIST 2017-2018 INCOME ELIGIBILITY (Choose ONE) POINTS AWARDED Categorically eligible (at or below 100% FPL, TANF, Supplemental Security Income-SSI, Foster, Homeless) 100 101-130% FPL 50 Over 130% FPL 0 AGE ELIGIBILITY (Choose ONE) POINTS AWARDED HS Preschool Programs Age 4 by August 31 100 Age 3 by August 31 50 Age 3 August 31 and before December 31 0 Age 3 after December 31 - 200 EHS Infant/Toddler Programs Age 1 or 2 by August 31 20 Prenatal - 1 year old 30 SPECIAL NEEDS POINTS AWARDED Homeless 200 Diagnosed disabilities (has an IEP or IFSP) 2 Agency referral 10 OTHER FACTORS POINTS AWARDED Homeless within the last year 2 Teen parent 2 Domestic violence 2 Parental substance abuse issues (or in recovery) 2 Incarcerated parent 2 Parental disability (developmental, physical, mental health) 2 Single parent 2 CPS involved 2 English language learners 2 Student at Community Colleges of Spokane (at least 6 credits or ABE/ESL) 5 Working parents 5 Sibling of currently enrolled child 10 Other (examples: divorce / separation or death within past 12 months, family trauma, i.e., house fire, major illness, victim of violent crime, etc.) 2 Total Points 0 SITE-SPECIFIC POINTS AWARDED POINTS AWARDED Child’s name Staff initials
ccs-98-126WORD.docx