South Carolina Association of Community Action Partnerships

Early Head Start Child Care Partnerships

Home Visit/Parent Conference Confirmation Form

Performance Standards

45 CFR 1304.21 (a)(2)(iii) Parents must be encouraged to participate in staff-parent conferences and home visits to discuss their child’s development and education.

45 CFR 1304.4 (i)(2) The child’s teacher in center-based programs must make no less than two home visits per program year to the home of each enrolled child.


Complete this portion 3 day prior to scheduled visit.

Child's Last Name: *
Child's First Name: *
Child's Middle Name:
Parent's Last Name: *
Parent's First Name: *
Parent's Middle Name:
Teacher's Name: *
Classroom: *
Center: *


You have scheduled a Home Visit for (date) starting at (time) (am/pm), to be conducted at:
Address Line 1: *
Address Line 2:
City: *
State: *
Zip Code: *


I will participate in the home visit on the above date and discuss:

I confirm that I have read and understand this form. *

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Parent Signature
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