In-Kind (Non-federal share) – Drake University Head Start

In-Kind

Role(Required)

Parent/ Volunteer/ Donor Name

First Last

Name of Community Agency, Organization, or Program

Volunteer Activity(Required)

How many of your children are CURRENTLY enrolled in Head Start/ Early Head Start?

Please enter a number from 0 to 6.

Head Start/ Early Head Start Child Name

If you have more than one enrolled child:
PARENT COMMITTEE MEETINGS OR DONATIONS - enter the name of the OLDEST enrolled child in your family
ALL OTHER VOLUNTEER ACTIVITIES: Enter the name of the child you were working with or on whose behalf you were participating (Example: if you attended a Policy Council meeting and you are a rep for Early Head Start Home Visiting, enter the information for your EHS home visiting child.)

First Last

Which program does your child attend?

Where is your child's program located?

Head Start/ Early Head Start Child 2 Name

First Last

Child 2 Program

Child 2 Site

Head Start/ Early Head Start Child 3 Name

First Last

Child 3 Program

Child 3 Site

Head Start/ Early Head Start Child 4 Name

First Last

Child 4 Program

Child 4 Site

Head Start/ Early Head Start Child 5 Name

First Last

Child 5 Program

Child 5 Site

Head Start/ Early Head Start Child 6 Name

First Last

Child 6 Program

Child 6 Site

Names of All Adults Attending

You do not need to list the parent/guardian whose name is already at the top of this form.

Names of All Children Attending

You do not need to list the child/ children already listed above.

Participation/ Donation Date

Time Spent

Activity

ACTIVITIES COUNT FOR 15 MINUTES OF IN-KIND
Read a book - reading, looking at, or talking about books
Life skills - age-appropriate skills such as setting the table, cooking/ food prep, brushing teeth, getting dressed, tying shoes
Motor skills - age-appropriate skills such as picking up objects, using silverware, catching a ball

What did you do during that time?

Donation Type(Required)

Items Donated(Required)

Please list names of items and quantities.

Estimated Value of Donation

Do not include monetary donations.

Amount Donated

Total Donation

Signature(Required)