Form 1 Follow-up Needsw Assessment Feedback Form

Head Start Program Performance Standards

Professional Development Institute

_{Follow-up Needs Assessment Feedback Form} OMB #0970-0401

Expiration Date: 05/31/2018

_{Grantee Information}

Grantee Name:	Event Location & Date:
Contact Person:	Contact E-mail:

_{Head Start Management Systems Wheel}

The following information will be used to prioritize and plan follow-up T/TA

_support.

Check all that apply

_{Quality Child & Family Outcomes} Individualized TA Group or Cluster Not Sure

ERSEA _{  } Education _{  } Health _{  } Mental Health _{  }

Family & Community Engagement _{  }

Leadership & Governance _{  }

Management Systems Individualized TA Group or Cluster Not Sure ^{Program Planning & Service System Design} _{  } Data & Evaluation _{  }

Fiscal Management _{  } Community Assessment _{  } Self-Assessment _{  }

Facilities & Learning Environment	Individualized TA 	Group or Cluster 	Not Sure 
Transportation			
Technology & Information Systems			
Training & Professional Development			
Communication			
Recordingkeeping & Reporting			
Ongoing Monitoring & Continuous Improvement			
Human Resources			

Additional details, questions, comments or considerations:

Paperwork Reduction Act Burden Statement: This collection of information is voluntary. Public reporting burden for this collection of information is estimated to average 4 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

^{These materials were developed for OHS/Region III under Contract No. HHSP233201500009C by ICF International Region III ACF Office of Head}

Start: 150 South Independence Mall West, Philadelphia PA, 19106 / T/TA Office: 215-861-4017