Iowa KidSight
   A State-Wide Vision Screening Program for Infants and Children    

Standard Forms for Download

• Standard Forms For:
  • Iowa KidSight Lion Volunteers
  • Area Education Agencies (AEA)
  • Head Start Programs
  • Health Agencies and others

Standard Forms for Iowa KidSight Lion Volunteers

Informational Brochure (pdf)

Informational Brochure (Viniendo A sus Sentidos) - Spanish (pdf)

Screening Cover Sheet (pdf)

Screening Cover Sheet (Word doc.)

Pre-Screening Form (pdf)

Pre-Screening Form (Word doc.)

Consent Form (pdf) - (must also print result form)

Consent Form - Spanish (pdf) - (must also print result form)

Result Form (pdf)

Result Form - Spanish (pdf)

Standard Forms for AEA

AEA 1

• AEA 1 Consent Form (pdf) - (must also print result form)

• AEA 1 Consent Form - Spanish (pdf) - (must also print result form)

AEA 3

• AEA 3 Consent Form (pdf) - (must also print result form)

• AEA 3 Consent Form - Spanish (pdf) - (must also print result form)

AEA 4

• AEA 4 Consent Form (pdf) - (must also print result form)

• AEA 4 Consent Form - Spanish (pdf) - (must also print result form)

AEA 5

• AEA 5 Consent Form (pdf) - (must also print result form)

• AEA 5 Consent Form - Spanish (pdf) - (must also print result form)

AEA 8

• AEA 8 Consent Form (pdf) - (must also print result form)

• AEA 8 Consent Form - Spanish (pdf) - (must also print result form)

AEA 9

• AEA 9 Consent Form (pdf) - (must also print result form)

• AEA 9 Consent Form - Spanish (pdf) - (must also print result form)

AEA 10

• AEA 10 Consent Form (pdf) - (must also print result form)

• AEA 10 Consent Form - Spanish (pdf) - (must also print result form)

AEA 11

• AEA 11 Consent Form (pdf) - (must also print result form)

• AEA 11 Consent Form - Spanish (pdf) - (must also print result form)

AEA 12

• AEA 12 Consent Form (pdf) - (must also print result form)

• AEA 12 Consent Form - Spanish (pdf) - (must also print result form)

AEA 13

• AEA 13 Consent Form (pdf) - (must also print result form)

• AEA13 Consent Form - Spanish (pdf) - (must also print result form)

AEA 14

• AEA 14 Consent Form (pdf) - (must also print result form)

• AEA 14 Consent Form - Spanish (pdf) - (must also print result form)

AEA 267

• AEA 267 Consent Form (pdf) - (must also print result form)

• AEA 267 Consent Form - Spanish (pdf) -(must also print result form)

Great Prairie AEA (Previously AEA 15)

• Great Prairie AEA Consent Form (pdf) - (must also print result form)

• Great Prairie AEA Consent Form - Spanish (pdf) - (must also print result form)

Standard Forms for Head Start

Community Opportunities Inc. Head Start

• Community Opportunities Inc. Head Start Consent Form (pdf) - (must also print result form)

• Community Opportunities Inc. Head Start Consent Form - Spanish (pdf) - (must also print result form)

Des Moines County Head Start

• Des Moines County Head Start Consent Form (pdf) - (must also print result form)

• Des Moines County Head Start Consent Form - Spanish (pdf) - (must also print result form)

Drake University Head Start

• Drake University Head Start Consent Form (pdf) - (must also print result form)

• Drake University Head Start Consent Form - Spanish (pdf) - (must also print result form)

Community Action of Eastern Iowa Head Start

• Community Action of Eastern Iowa Consent Form (pdf) - (must also print result form)

• Community Action of Eastern Iowa Consent Form - Spanish (pdf) - (must also print result form)

Council Bluffs Head Start

• Council Bluffs Head Start Consent Form (pdf) - (must also print result form)

• Council Bluffs Head Start Consent Form - Spanish (pdf) - (must also print result form)

Madison County Head Start

• Madison County Head Start Consent Form (pdf) - (must also print result form)

• Madison County Head Start Consent Form - Spanish (pdf) - (must also print result form)

Maquoketa Head Start

• Maquoketa Head Start Consent Form (pdf) - (must also print result form)

• Maquoketa Head Start Consent Form - Spanish (pdf) - (must also print result form)

MATURA Action Head Start

• MATURA Action Head Start Consent Form (pdf) - (must also print result form)

• MATURA Action Head Start Consent Form - Spanish (pdf) - (must also print result form)

SIEDA Head Start

• SIEDA Head Start Consent Form (pdf) - (must also print result form)

• SIEDA Head Start Consent Form - Spanish (pdf) - (must also print result form)

Tri County Head Start

• Tri County Head Start Consent Form (pdf) - (must also print result form)

• Tri County Head Start Consent Form - Spanish (pdf) - (must also print result form)

West Central Community Action Head Start

• West Central Community Action Head Start Consent Form (pdf) - (must also print result form)

• West Central Community Action Head Start Consent Form - Spanish (pdf) - (must also print result form)

Your Inc. Head Start

• Y.O.U.R. Inc. Head Start Consent Form (pdf) - (must also print result form)

• Y.O.U.R. Inc. Head Start Consent Form - Spanish (pdf) - (must also print result form)

Standard Forms for Health Agencies and Others

Cedar County Public Health

• Cedar County Public Health Consent Form (pdf) - (must also print result form)

• Cedar County Public Health Consent Form -Spanish (pdf) - (must also print result form)

Children's Village West

• Children's Village West Consent Form (pdf) - (must also print result form)

• Children's Village West Consent Form - Spanish (pdf) - (must also print result form)

Clinton County Public Health

• Clinton County Public Health Consent Form (pdf) - (must also print result form)

• Clinton County Public Health Consent Form -Spanish (pdf) - (must also print result form)

Community Health of Jones County

• Community Health of Jones County Consent Form (pdf) - (must also print result form)

• Community Health of Jones County Consent Form - Spanish (pdf) - (must also print result form)

Foundation 2

• Foundation 2 Consent Form (pdf) -(must also print result form)

• Foundation 2 Consent Form - Spanish (pdf) - (must also print result form)

Mid-Iowa Community Action, Inc. Collaborative Project

• Mid-Iowa Community Action, Inc. Collaborative Project Consent Form (pdf) - (must also print result form)

• Mid-Iowa Community Action, Inc. Collaborative Project Consent Form - Spanish (pdf) - (must also print result form)

Mid-Sioux Opportunity

• Mid-Sioux Opportunity Consent Form (pdf) - (must also print result form)

• Mid-Sioux Opportunity Consent Form - Spanish (pdf) - (must also print result form)

New Opportunities

• New Opportunities Consent Form (pdf) - (must also print result form)

• New Opportunities Consent Form - Spanish (pdf) - (must also print result form)

Parents as Teachers

• Parents as Teachers Consent Form (pdf) - (must also print result form)

• Parents as Teachers Consent Form - Spanish (pdf) - (must also print result form)

Unite for Sight

• Unite for Sight Consent Form (pdf) - (must also print result form)

• Unite for Sight Consent Form Spanish (pdf) - (must also print result form)

Washington County Public Health

• Washington County Public Health Consent Form (pdf) - (must also print result form)

• Washington County Public Health Consent Form - Spanish (pdf) - (must also print result form)

updated 03-19-2009