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Run: Head Start Enrollment and Selection Criteria Point Ranking Form

Use this Head Start enrollment scoring form to document eligibility, apply selection criteria consistently, and keep an auditable record of who was prioritiz...

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Submission Overview

Submission Date (required)

Program Year (required)

Applicant ID (required)

Use the program's internal applicant identifier. Avoid entering unnecessary personal data.

Applicant Name (required)

Enter the child's name only if needed for internal enrollment tracking.

Reviewer Name (required)

Reviewer Role (required)

Eligibility and Priority Factors

Is the applicant eligible for ranking review? (required)

Eligibility Basis (required)

Does the applicant meet any priority factor? (required)

Priority Factors

Priority Notes

Document only the facts needed to support the priority determination.

Selection Criteria Point Ranking

Income Eligibility Points (required)

Family Need Points (required)

Disability or Special Services Points (required)

Homelessness Points (required)

Foster Care Points (required)

Other Program-Defined Criteria Points

Total Ranking Points

Ranking Decision

Ranking Status (required)

Rank Order

Enter the applicant's position in the ranked list, if applicable.

Selection Reason (required)

Explain the basis for the ranking decision using the approved selection criteria and any applicable priority factors.

Does this case require additional review? (required)

Follow-Up Notes

Approval and Attestation

Reviewer Attestation (required)

Yes No N/A

Approval Signature (required)

Approval Date (required)

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Email (required)

Your name (optional)

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