Group systematic selection form.xlsx

	A	B	C	D	E	F	G	H	I	J	K	L	M	N	O	P	Q	R	S	T	U	V	W	X
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3	ISD:								Date of Screening:
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5	APPROVED	DIAGNOSED DISABILITY	100-130%	OVER INCOME	BIRTHDATE	CHILD'S AGE AS OF SEPT. 1	CODE #	# IN FAMILY	Eligibility Status 500/300/200/180/50/10	Disability Status 40/20/10/5	Child has obvious medical need	Early Head Start	Previously enrolled in a Head Start Program	Child's primary language is not English	Non-parent caregiver	Single parent home	Family has 3 or more children	Parent working/school/training	Family Preservation - Open CPS Case	Anyone in family receives Medicaid	Anyone in family receives SNAP	Stressors	TOTAL POINTS	DATE OF APPLICAION
6	APPROVED	DIAGNOSED DISABILITY	100-130%	OVER INCOME	BIRTHDATE	CHILD'S AGE AS OF SEPT. 1	CODE #	# IN FAMILY			10	15	15	15	100	15	10	10 or 20	30	5	10	2 pts. Each	TOTAL POINTS	DATE OF APPLICAION
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