Education and Early Childhood Development 1304 by pWh1aG

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									                                      Education and Early Childhood Development 1304.21 (a)(2)(i),(iii)
                                      Family Partnerships 1304.40 (e)(1) & (5), 1304.40 (i)(2)

                        South Plains Community Action Association
                          Head Start & Early Head Start Division

Site Name: ______________________ Teacher’s Name:__________________
Child’s Name: ___________________________ Date: ___________________

Parent Home Visit // Parent Conference Form (Circle One)
Address: _______________            //   (Check one)   Site: _________Phone:_________
Discussion of child’s overall School Readiness:
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Upcoming Themes/Activities are:
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My Goals for My Child and Comments: (Parent-Please do not leave blank.)
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Parent Ideas for Lesson Plans and Curriculum: (Parent-Please do not leave blank.)
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Parent’s Signature: ___________________________________________________
Teacher’s Signature: __________________________________________________
         WHITE: Child’s Folder                               Yellow: Parent’s Copy

								
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