~HSCFDC Documentation/Monitoring System~
Title of Form:
Related Policy:
Verbal Exchange of Information
Created to ensure compliance with the Head Start Performance Standards
confidentiality guidelines for the verbal exchange of information to support
the child’s educational planning.
Program Area: 1304.21 Education and Early Childhood Services
1304.20 Child Health and Developmental Services
1304.22 Child Health and Safety
1304.23 Child Nutrition
1304.24 Mental Health
1304.40 Family Services
1308 Disability Services
Procedures
Filled Out By:
Timeline:
Specific
Directions:
Submitted To:
Timeline:
Filed In:
Note: For
duplicate or
triplicate forms,
please note where
each copy of the
form is filed.
Teachers
CFMS
HSM
ED
As information is needed
1) As soon as there is evidence that information is needed from a
community partner, this form is completed in collaboration with the
child’s parents.
2) The parents must sign and date the form.
3) Upon completion of the form, the pink copy is given to the parent.
The CFSM or HSM will communicate with Teacher regarding the
placement of the yellow and white copy of the form. A copy of the
original form will be kept in the CFSM or HSM file.
4) The original form is given to the community partner and/or LEA for
reference purposes.
5) Upon completion of the form the agreement is valid for six months.
CFSM
HSM
4-5 business days upon completion of the form
White (original) – Community Partner or LEA
Yellow – Child’s Classroom File
Pink – Parent
Copy of original – CFSM or HSM file