Appendix D - Program Observation Sheet

Appendix D - Program Observation Sheet_revised.docx

School Readiness Goals and Head Start Program Functioning

Appendix D - Program Observation Sheet

OMB: 0970-0438

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OMB Control No.: 0970-xxxx

Expiration Date: xx/xx/20xx


Appendix D: Site Visit Information and Observational Sheet

Site visitors should complete as much of this sheet prior to the visit based on PIR data and the telephone interview. Information should be confirmed and other sections should be completed while on site. These data should capture descriptive information about the program organization and context which will later support our analyses and reporting. Reading these notes should give us a snapshot of the program and what occurred during the visit.



Program ID#: ___________________________

Program options: Center-based: # of days per week? _____ Full-day or Part-day?

Home-based

Combination option

Family child care

Other, specify:

Number of Head Start children served in center-based: ________ in home-based: ________



Number of EHS children served in center-based: ________ in home-based: ________



If applicable, number of Head Start classrooms: _________ EHS classrooms: ______



Agency Type:

Community Action Agency (CAA)

School System

Charter School

Private/Public Non-Profit (Non-CAA) (e.g., church or non-profit hospital)

Private/Public For-Profit (e.g. for-profit hospitals)

Government Agency (Non-CAA)

Agency Affiliation:

A secular or non-religious agency

A religiously affiliated agency or organization providing essentially secular services



Agency Description:

Grantee that directly operates program(s) and has no delegates

Grantee that directly operates programs and delegates service delivery

Grantee that maintains central office staff only and operates no program(s) directly

Grantee that delegates all of its programs; it operates no programs directly and maintains no central office staff

Delegate agency



Brief description of program location(s) and setting(s) visited:

























Brief description of facility and space (age and functionality, layout of space, general quality of indoor and outdoor space and resources):

















Were there any disruptions during the visit that affected data collection?







Were all interviews completed? If no, which were not completed and why?









Were all interviews recorded? If no, which were not recorded and why?





How would you describe the level of engagement of each respondent group?

Directors?



Managers/Coordinators?



Teachers/Home Visitors?



Parents?



Governing body?



Policy council?



LEA?



Additional summary notes:



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AuthorHeather Sandstrom
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