Report Item Lost/Stolen

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Report Item Lost/Stolen

Please use this form to report any lost or stolen items from the inventory at your Center.

IMPORTANT: Any items that have been lost or stolen will require a submitted signed affidavit and/or police report, when applicable.

Refer to Center Inventory Procedure as needed for specific guidance.

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* Indicates required question

Center or Site Name: *

Your answer

Staff Name: *

Your answer

Preferred Contact Information: *

Your answer

What is the funding source for this item (mark all that apply)? *

ECEAP

HEAD START 2059

HEAD START 715

EARLY HEAD START 2059

EARLY HEAD START CCP

Required

Which category does this inventory item fall under? *

Inventory item was lost

Inventory item was stolen

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