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Staffing Chart - Complete one for each classroom. - Submit Staff/Consultant Profile Sheet for new staff members - Attach current certification Program Name Classroom Name

Name Position Certification/ Endorsement Supervisor Supervisor Certification/

Endorsement First Aid/CPR Certified

Name Position Certification/ Endorsement Supervisor Supervisor Certification/

Endorsement First Aid/CPR Certified

Name Position Certification/ Endorsement Supervisor Supervisor Certification/

Endorsement First Aid/CPR Certified

Name Position Certification/ Endorsement Supervisor Supervisor Certification/

Endorsement First Aid/CPR Certified CDS Program Approval Staffing Chart- Staff changes must be provided to CDS State IEU within 30 days. Form Updated 1.3.13

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