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    Master Enrollment List - 1

    Uploaded by

    brayan uy
    This document is a master enrollment list for a Head Start program for a fiscal year and month. It includes information on enrolled children such as name, date of birth, attendance, date of termination, reimbursement eligibility category, and civil rights information. The list is certified by a Head Start representative and includes subtotals.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd

    Master Enrollment List - 1

    Uploaded by

    brayan uy
    21 views2 pages
    This document is a master enrollment list for a Head Start program for a fiscal year and month. It includes information on enrolled children such as name, date of birth, attendance, date of termination, reimbursement eligibility category, and civil rights information. The list is certified by a Head Start representative and includes subtotals.

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    kfkfghk

    Original Title

    Master Enrollment List_1

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    © © All Rights Reserved

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    This document is a master enrollment list for a Head Start program for a fiscal year and month. It includes information on enrolled children such as name, date of birth, attendance, date of termination, reimbursement eligibility category, and civil rights information. The list is certified by a Head Start representative and includes subtotals.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    21 views2 pages

    Master Enrollment List - 1

    Uploaded by

    brayan uy
    This document is a master enrollment list for a Head Start program for a fiscal year and month. It includes information on enrolled children such as name, date of birth, attendance, date of termination, reimbursement eligibility category, and civil rights information. The list is certified by a Head Start representative and includes subtotals.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Download as doc, pdf, or txt
    You are on page 1of 2

    Master Enrollment List

    Fiscal Year:

    Last Name

    Month:

    First Name

    Date of
    Birth

    Licensed Capacity:

    Attend
    ed

    Date of
    Terminat
    ion

    Date of
    IES
    Determina
    tion

    Reimbursement
    Eligibility Category
    Reduc
    Free
    ed
    Paid

    Titl
    e
    XX

    Hea
    d
    Star
    t

    1
    2
    3
    4
    5
    6
    7
    8
    9
    1
    0
    1
    1
    1
    2
    1
    3
    1
    4
    1
    5
    1
    6
    1
    7
    1
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    1
    9
    Certification: The children indicated above are currently enrolled participants in the Head Start Program.
    Authorized Head Start Representative Signature: ________________________________________
    PAGE NUMBER: ________

    Date:______________________

    Civil Rights
    Info
    Ethnici
    ty
    Race

    2
    0
    2
    1
    Totals:

    Certification: The children indicated above are currently enrolled participants in the Head Start Program.
    Authorized Head Start Representative Signature: ________________________________________
    PAGE NUMBER: ________

    Date:______________________

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