HS EHS Grantee Approval Over State Income Request Form 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date of your Grantee Approval request in the designated field.
3. Next, input your agency's name to identify the organization submitting the request.
4. Fill in the name of the person completing this form for accountability and contact purposes.
5. Indicate the total number of children currently on your agency’s wait list to provide context for your request.
6. Specify how many children are on the wait list for the specific site where you wish to enroll a child.
7. Complete additional fields regarding children with IEPs or IFSPs, including whether you have met the 10% mandate for children with disabilities.
8. Provide details about the applicant, including their name, date of birth, family size, and documented family income.
9. List any selection criteria that apply to the child and indicate their documented disability as per IEP guidelines.
10. Finally, explain why Head Start is beneficial for this child compared to other available programs and include any relevant family information.

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