|
Provider Change Form |
English (PDF)
|
|
|
State Fiscal Quarterly Report |
English (Excel)
|
|
|
Provider Direct Deposit Authorization Form |
English (PDF)
|
|
|
File Checklist (Kinship License) |
English (Word)
|
|
|
Provider Registration Form |
English (PDF)
|
|
00-002 |
COVID- 19 Prevention, Intervention and Quarantine Plan |
English (Word)
|
|
00-005 |
HVSA Expansion Application Template |
English (Word)
|
|
00-005A |
2022 Spring HVSA Tribal Expansion Funding Application |
English (Word)
|
|
00-005b |
2023 HVSA Application for Funding Home Visiting Exploration Planning |
English (Word)
|
|
02-003 |
Application for Early Learning Advisory Council |
English (Word)
|
|
02-003a |
Application for Provider Supports Subcommittee |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
02-003b |
Parent Advisory Group (PAG) Application |
English (Word)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
02-006 |
Treatment Foster Care Initiative (TFCI) Referral |
English (Word)
Treatment Foster Care Initiative (TFCI) Information
|
|
02-020 |
Guide to Background Checks |
English (PDF)
|
|
02-026 |
Unsung Hero Nomination Form |
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
02-031 |
WA State Citizen Review Panels (CRP) Data Request Form |
English (Word)
|
|
02-206 |
Statement of Earnings |
English (Word)
English (PDF)
Albanian (PDF)
Spanish (PDF)
|
|
03-374B |
Agreement on Nondisclosure of Confidential Information-Non Employee |
English (Word)
English (PDF)
|
|
03-415 |
Facility Short Term Use Application |
English (Word)
English (PDF)
|
|
03-492 |
Foster Parent Recipient Shared Leave |
English (Word)
English (PDF)
|
|
03-493 |
Foster Parent Donor Shared Leave |
English (Word)
English (PDF)
|
|
04-220 |
Family Ancestry Chart |
English (Word)
English (PDF)
|
|
04-225 |
CBCAP Quarterly Report |
English (Word)
|
|
05-001 |
Expression of Interest |
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
05-002 |
Funding Organization Commitment |
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (PDF0
Spanish (Word)
|
|
05-003 |
Provider Application Form |
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
05-004 |
ECEAP Community Funded |
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
05-005 |
Education Appeal |
English (Word)
English (PDF)
|
|
05-006 |
ECEAP Pre-screen & Application |
2023-2024 Combined Pre-screen and Application
2023-2024 Pre-screen (English PDF)
2023-2024 Application
2023-2024 Amharic Combined Pre-screen and Application
2023-2024 Arabic Combined Pre-screen and Application
2023-2024 Korean Combined Pre-screen and Application
2023-2024 Russian Combined Pre-screen and Application
2023-2024 Spanish Combined Pre-screen and Application
2023-2024 Spanish Pre-screen
2023-2024 Spanish Application
2023-2024 Ukranian Combined Pre-screen and Application
2023-2024 Vietnamese Combined Pre-screen and Application
|
|
05-007 |
ECEAP Contractor Financial Disclosure Certification |
English (PDF)
|
|
05-008 |
Early ECEAP Prescreen & Application (Combined Form) |
2023-2024 Combine Pre-screen and Application
Spanish Pre-screen (fillable PDF)
Spanish 2023-2024 Application (fillable PDF)
Spanish Combined 2023-2024 (fillable PDF)
Spanish Pre-screen (fillable PDF)
Spanish 2023-2024 Application (fillable PDF)
|
|
05-009 |
ECEAP Professional Development Plan Assistant Teacher |
English (Word)
English (PDF)
|
|
05-010 |
ECEAP Professional Development Plan Lead Teacher |
English (Word)
English (PDF)
|
|
05-012 |
Approval of New Early ECEAP Site/Classroom |
English (Word)
|
|
05-021 |
ECEAP Contractor Alternative Attendance Plan Request |
English (Word)
English (PDF)
|
|
05-022 |
ECEAP Contract Waiver-Variance Request to ECEAP Requirements |
English (Word)
English (PDF)
|
|
05-023 |
ECEAP Contractor Purchase Request |
English (Word)
English (PDF)
|
|
05-024 |
ECEAP Contractor Equipment Disposal Request |
English (Word)
English (PDF)
|
|
05-026A |
ECEAP and B-3 Services Application |
Exhibit A: ECEAP and B-3 Services Application
Exhbit B: Letters of Support and Collaboration
Exhibit C: Coordination with Neighboring Head Start/ECEAP and Tribal Organizations (Scored)
Exhibit D: Budget
Exhibit F: Certifications and Assurances
|
|
05-027 |
ECLIPSE Services Application Packet |
Exhibit D: Startup Budget
Exhibit E: ECLIPSE Services Application Form
Exhibit F: Certifications and Assurances
|
|
05-031 |
Parent Consent to Transfer ELMS Records |
English (Word)
English (PDF)
Spanish (PDF)
|
|
05-032 |
ECEAP Complex Needs Fund (CNF) Grant Application Guidance |
English Application Guidance (PDF)
|
|
05-034 |
ECLIPSE RFA Applications and Guides |
Request for Application References
Budget Form
ECLIPSE Request for Application Guide
ECLIPSE Minimum Service Delivery Requirements Table
|
|
05-041 |
Licensing Dvisions Practice Change Request Review & Approval |
English (Word)
|
|
05-041A |
Licensing Division Practice Change Request |
English (Word)
|
|
05-050 |
Citizen Review Panel Membership Application |
English (Word)
|
|
05-051 |
Citizen Review Panel Confidentiality Agreement |
English (Word)
|
|
05-060 |
Evidence Based Readiness Assessment |
English (Word)
|
|
05-061 |
Combined In-Home Service (CIHS) Inquiry |
English (Word)
|
|
05-250 |
Certification Regarding Environmental Tobacco Smoke |
English (Word)
English (PDF)
|
|
05-305 |
ADA/504 Discrimination Complaint/Grievance Form |
English (PDF)
|
|
05-320 |
2018-19 Financial Disclosure Certification |
English (PDF)
|
|
05-325 |
ECEAP Porgram Monitoring Document Review Checklist |
English (Word)
English (PDF)
|
|
06-006 |
Pinwheel Order Form |
English (PDF)
|
|
06-010 |
Electronic Attendance System Vendor Approved Checklist |
English (Word)
English (PDF)
|
|
06-097 |
Provider File Action Request |
English (Word)
English (PDF)
|
|
06-160 |
Adoption Support Monthly Counseling Billing |
English (Word)
English (PDF)
|
|
06-165 |
Extended Foster Care (EFC) Denial Letter |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
06-166 |
Individual Training Plan |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
06-172 |
Domestic Violence Prevention Account |
English (Word)
English (PDF)
|
|
06-179 |
Education and Training Voucher (ETV) Spending Plan |
English (Excel)
|
|
07-020 |
ECEAP Service Purchase Request |
English (Word)
English (PDF)
|
|
07-085 |
Client Travel Approval Quick Reference Guide |
English (PDF)
|
|
07-090 Contact Forms Manager for translation revisions |
Caregiver Monthly Transportation Reimbursement |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
07-110 |
Child Care Stabilization Grant Application – Family, Friend, and Neighbor (FFN) License- Exempt Providers |
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
07-110A |
Child Care Stabilization Grant Spend Period Extension Request |
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
07-110B |
Stabilization Grant Receipt Verification Form Program and Add-On Amounts |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
07-110C |
Stabilization Grant Receipt Verification Form Workforce Amounts |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
07-112 |
Spring 2021 Child Care COVID -19 Grant Receipt Verification |
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
07-112a |
Early Achievers Needs-Based Grant Receipt Verification Form |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
08-050 |
Request/Certification of Data Destruction |
English (Word)
English (PDF)
|
|
09-007 |
Petition for Review of Initial Decision (Appeal) |
English (Word)
English (PDF)
|
|
09-008 |
Victim/Witness Notification Program Enrollment |
English (PDF)
|
|
09-010 |
Child Welfare History |
English (Word)
|
|
09-012 |
Request for Certificate of Parental Improvement (CPI) |
English (Word)
English (PDF)
|
|
09-013 |
Vendor Affidavit of Lost, Stolen or Destroyed Warrant |
English (Word)
English (PDF)
|
|
09-026 |
DSO & Jail Removal Data Form |
English (Word)
|
|
09-031 |
Authorization By Subject of Records Requested |
English (Word)
English (PDF)
|
|
09-054 |
Waiver of Notice of Further Hearing |
English (Word)
English (PDF)
|
|
09-056 |
Dependent/Ward of the Court Verification |
English (Word)
English (PDF)
|
|
09-082 |
Five Day Notification to Move |
English (Word)
English (PDF)
|
|
09-093 |
School Notification |
English (Word)
English (PDF)
|
|
09-100 |
Hiring Education Affidavit Request (Early Learning) |
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
09-101 |
Hiring Education Affidavit Request (School Age) |
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
09-102 |
Hiring Education Affidavit Request (Outdoor Nature-Based) |
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
09-104 |
ICPC Closure Letter |
English (Word)
English (PDF)
|
|
09-111 |
Continuous Quality Improvement Confidentiality Agreement |
English (Word)
English (PDF)
|
|
09-121 |
Waiver of Right to Receive Written Information on Adoption Support Program Limitation |
English (Word)
English (PDF)
|
|
09-126 |
Local Indian Child Welfare Advisory Committee Confidentiality Agreement |
English (Word)
English (PDF)
|
|
09-127 |
Rights of Children and Youth in Foster Care |
English (Word)
English (PDF)
|
|
09-128 |
Child Fatality Case Review Confidentiality Agreement |
English (Word)
English (PDF)
|
|
09-129 |
Child Near Fatality Case Review Confidentiality Agreement |
English (Word)
English (PDF)
|
|
09-131 |
Background Check Request/Decision |
English (Word)
English (PDF)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
09-132 |
Employee Background Check Request/Decision |
English (Word)
English (PDF)
|
|
09-133 |
Group Care Background Check Request/Decision Form |
English (Word)
English (PDF)
|
|
09-134 |
Relative Inquiry |
English (PDF) Download and save to desktop before filling in form.
Marshallese (PDF)
Trukese (PDF)
|
|
09-154 |
NCIC Purpose Code C Background Check Summary |
English (Word)
English (PDF)
|
|
09-160 |
Background Check Hearing Request Form |
English (Word)
English (PDF)
|
|
09-162 |
Background Check Reconsideration Request |
English (Word)
English (PDF)
|
|
09-164 |
Request for Early Learning Background Check Results |
English (Word)
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
09-165 |
Portable Background Check Application |
English (PDF)
|
|
09-539 |
Inquiry to Indian Tribe |
English (Word)
English (PDF)
|
|
09-611 |
Release and Consent for Child Specific Recruitment |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
09-653 |
Background Check Authorization |
English (Word)
English (PDF)
Amharic (PDF)
Cambodian (PDF)
Chinese (PDF)
Chinese (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)
|
|
09-761 |
Indian Identity Request |
English (Word)
English (PDF)
|
|
09-765 |
Declaration of Adoption Facilitator - Indian Child |
English (Word)
English (PDF)
|
|
09-837 |
Disclosure of Confidential HIV / AIDS Information |
English (Word)
English (PDF)
|
|
09-966 |
Authorization to Release Information to the Court |
English (Word)
English (PDF)
|
|
09-997 |
Adoption Support Worksheet |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
09-998 |
Application for the Adoption Support Program and/or Reimbursement of Adoption Finalization Costs |
English (Word)
English (PDF)
Vietnamese (PDF)
|
|
10-006B |
License Letter and Certificate for Group Care |
|
|
10-016 |
File Checklist and Certification for License of Foster Home |
English (Word)
|
|
10-042 |
Child Protective Services Casework Checklist |
English (Word)
English (PDF)
|
|
10-043 |
Home Study |
English (Word)
Spanish (PDF)
Spanish (Word)
Tigrigna (PDF)
Samoan (PDF)
Somali (PDF)
|
|
10-045 |
Policies and Procedures for Child Placing Agency (CPA) Foster Care |
|
|
10-045A |
Policies and Procedures for Child Placing Agency (CPA) Adoption Only |
|
|
10-045B |
Policies and Procedures for Group Care |
|
|
10-046 |
Budget for Child Placing Agency (CPA) |
|
|
10-046B |
Budget for Group Care |
|
|
10-047 |
Administrative Approval & Waiver for Child Placing Agency (CPA) |
|
|
10-047B |
Administrative Approval & Waiver for Group Care |
|
|
10-048 |
Adoptive Parent and Child Checklist for Child Placing Agency (CPA) |
|
|
10-049 |
Site Inspection Checklist (Health & Safety) for Child Placing Agency |
|
|
10-052 |
Day Treatment Checklist |
|
|
10-053 |
Resource and Assessment Center Checklist |
|
|
10-054 |
Staff Resident Home Checklist |
|
|
10-055 |
Group Receiving Center Checklist |
|
|
10-061 |
Child’s Registration |
English (Word)
English (PDF)
|
|
10-082 |
Adoption Support Agreement Review |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
10-083 |
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment |
English (Word)
English (PDF)
|
|
10-114 |
Adoption Data Card |
English (Word)
English (PDF)
|
|
10-166A |
Behavioral Rehabilitation (BRS) Referral |
English (Word)
English (PDF)
|
|
10-182 |
File Checklist (Foster License) |
English (Word)
|
|
10-182A |
File Checklist (Unlicensed) |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
10-182B |
File Checklist (Provisional Expedited License) |
English (Word)
|
|
10-182C |
File Checklist (Kinship License) |
English (Word)
|
|
10-183 |
Home Inspection Checklist (Licensed) |
English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
10-214 |
Pre-Authorization For Services |
English (Word)
English (PDF)
|
|
10-248 |
Compliance Agreement for Child Placing Agency (CPA) |
|
|
10-248 |
Compliance Agreement |
English (Word)
Spanish (PDF)
Spanish (Word)
|
|
10-248C |
Compliance Agreement for Group Care |
|
|
10-261 |
Foster Care Rate Assessment |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
10-290 |
WAC Agreements |
English (Word)
Amharic (PDF)
Oromo (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
10-354 |
Home Study or Reassessment Application |
English (Word)
Amharic (PDF)
Marshallese (PDF)
Oromo (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
10-395 |
Intensive Family Service Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary |
English (Word)
English (PDF)
|
|
10-405 |
Foster Home Reassessment |
English (Word)
|
|
10-405B |
Foster Home Move Reassessment |
English (Word)
|
|
10-408 |
Application for Child Care Agency License or Certification |
English (Word)
English (PDF)
|
|
10-408B |
Application for Group Care License |
|
|
10-416 |
Foster Home Monitoring Visit |
English (Word)
Spanish (PDF)
Spanish (Word)
|
|
10-419 |
Supervision Plan for Site Specific Conditions |
English (Word)
Spanish (PDF)
|
|
10-425 |
Reference Questionnaire (Certified Respite) |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
10-428 |
Caregiver Support Plan |
English (Word)
English (PDF)
|
|
10-432 |
Extended Foster Care Program Participation Agreement |
English (Word)
English (PDF)
French (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
10-453 |
Home Inspection Checklist (Kinship) |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
10-454 |
DCYF Caregiver Authorization |
English (PDF)
Laotian (PDF)
Mam (fillable PDF)
Spanish (fillable PDF)
|
|
10-455 |
Medication Log |
English (Word)
English (PDF)
|
|
10-459 |
Courtesy Supervision Referral |
English (Word)
English (PDF)
|
|
10-462 |
User Application and Acknowledgement |
English (Word)
English (PDF)
|
|
10-463 |
FamLink Data Access Request / Change |
English (Word)
English (PDF)
|
|
10-464 |
FamLink Access Application and Acknowledgement |
English (Word)
English (PDF)
|
|
10-474 |
FAR Family Assessment |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Cambodian (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Vietnamese (PDF)
|
|
10-475 |
Early Invention Program (EIP) Exit Summary |
English (Word)
English (PDF)
|
|
10-477 |
Adoption Support Program Application Checklist |
English (Word)
English (PDF)
|
|
10-479 |
Early Intervention Program (EIP) 90 Day Review |
English (Word)
English (PDF)
|
|
10-479 |
Early Intervention Program (EIP) 90 Day Review |
English (Word)
English (PDF)
|
|
10-480 |
Comprehensive Family Evaluation |
English (Word)
English (PDF)
|
|
10-484 |
Youth Run Prevention Plan |
English (Word)
English (PDF)
|
|
10-490 |
Child Specific Contract or Extra Supervision Rate Proposal |
English Excel
|
|
10-500 |
Acknowledgement of Child’s Adoptive File Provided to Adoptive Family: |
English (Word)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
|
|
10-537 |
Interstate Compact for the Placement of Children (ICPC) Parent Home Study Information |
10-537
10-537
Spanish (PDF)
Spanish (Word)
|
|
10-539 |
Interstate Compact for the Placement of Children (ICPC) Reference Questionnaire for Parent Home Study |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
10-540 |
Project SafeCare Monthly Summary |
English (Word)
English (PDF)
|
|
10-545 |
Family Feedback Questionnaire |
English (Word)
English (PDF)
|
|
10-546 |
Adoption Archive Request for Non-Identifying Information |
English (Word)
English (PDF)
|
|
10-566 |
Contracted Health and Safety Visit Referral |
English (Word)
English (PDF)
|
|
10-567 |
Contracted Health and Safety Visit Report |
English (Word)
English (PDF)
|
|
10-586 |
Preauthorization for In-Home Services |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
10-606 |
Adoptive Parent Counseling Preauthorization for Services |
English (Word)
English (PDF)
|
|
10-650 |
ESIT Authorization for Release of Records |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Chinese (PDF)
Farsi (PDF)
Khmer (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
11-010 |
Funding Opportunity: Perinatal Mental Health Community Capacity Building |
English (Word)
|
|
11-011 |
2022 Spring HVSA Expansion Funding Opportunity Letter of Intent to Apply |
English (Word)
|
|
11-011A |
HVSA Tribal Home Visiting Funding Opportunity Letter of Intent |
English (Word)
|
|
11-013 |
Community Based Child Abuse Prevention (CBCAP) Funding Opportunity |
English (Word)
|
|
11-014 |
Family Resource Center Capacity Building Funding Opportunity |
English (Word)
|
|
11-015 |
CBCAP Returning Programs |
English (Word)
|
|
11-016 |
Perinatal Mental Health Year-End Community Report Template |
English (Word)
|
|
11-017 |
Diaper Bank Partnership Quarterly Report Form |
English (Word)
|
|
11-018 |
Perinatal Mental Health Returning Program |
English (Word)
|
|
11-019 |
Diaper Bank Concrete Good for Families Quarterly Report Form |
English (Word)
|
|
11-020 |
Tribal Fatherhood Support Program Funding Opportunity |
English (Word)
|
|
11-021 |
HV-BAT Supplemental Form |
English (Word)
|
|
11-022 |
Family Resource Center Capacity Building Work Plan |
English (Word)
|
|
11-023 |
FRC Quarterly Report Form |
English (Word)
|
|
11-024 |
Tribal Fatherhood Supports Project Plan |
English (Word)
|
|
11-025 |
Option 1A |
English (Excel)
|
|
11-026 |
Option 1B |
English (Excel)
|
|
11-027 |
Option 2 |
English (Excel)
|
|
11-028 |
Tribal Fatherhood Quarterly Reports |
English (Word)
|
|
11-029 |
Quarterly Reporting Tool - Stengthen Families Locally |
English (Excel)
|
|
11-031 |
Strengthen Families Locally Priority Project Proposal |
English (Word)
|
|
11-032 |
Strengthen Families Locally (SFL) Budget Templatae |
English (Excel)
|
|
12-001 |
Special Needs Child Care Rate Request |
English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Dari (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tigrigna (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
13-001 |
Applicant Medical Report- Confidential |
English (Word)
Oromo (PDF)
Samoan (PDF)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
Tagalog (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
13-001A |
Applicant Medical Self Report |
English (Word)
Marshallese (PDF)
Oromo (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
13-001B |
Applicant Mental Health Report |
English (Word)
Spanish (PDF)
|
|
13-041 |
Family Genetic and Medical History |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
13-200 |
Health and Safety Review: Youth Interview |
English (Word)
|
|
13-904 |
Diabetes Care and Action Plan |
English (Word)
English (PDF)
|
|
13-907 |
Brief Assessment of Anxiety and PTSD: Caregiver/Parent |
English (Word)
English (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
|
|
14-001 |
Employment Verification for State Training |
English (Word)
English (PDF)
|
|
14-002 |
Trainer Observation Rubric |
English (Word)
English (PDF)
|
|
14-003 |
Trainer Observation Rubric (Self Paced) |
English (Word)
|
|
14-005 |
OJJDP Title II Pass Through Fund |
English (Word)
|
|
14-011 |
Enrollment Application Medical and Dental Benefits |
English (PDF) If using chrome, save form to desktop before filling in form
Somali (PDF)
Spanish (PDF)
|
|
14-011a |
Change Form Medical and Dental Benefits |
English (PDF)
Spanish (fillable PDF)
Somali (fillable PDF)
|
|
14-012 |
Consent for Release of Information |
English (Word)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Laotian (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Ukranian (PDF)
Vietnamese (PDF)
|
|
14-025 |
Early Achievers Extension Application |
English (Word)
Somali (Word)
Spanish (Word)
|
|
14-224 |
Statement from Landlord/Manager |
English (Word)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
French (PDF)
Japanese (PDF)
Karen (PDF)
Korean (PDF)
Laotian (PDF)
Lingala (PDF)
Mien (PDF)
Neplai (PDF)
Portuguese (PDF)
Punjabi (PDF)
Romanian (PDF)
Russian (PDF)
Rwanda (PDF)
Swahili (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (PDF)
Tagalog (PDF)
Turkish (PDF)
Trukese (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
14-252 |
Employment Verification |
English (Word)
English (PDF)
Albanian (PDF)
Amharic (PDF)
Cambodian (PDF)
Chinese (PDF)
Dar (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Lingala (PDF)
Mongolian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Swahili (PDF)
Tagalog (PDF)
Turkish (PDF)
Ukaranian (PDF)
Vietnamese (PDF)
|
|
14-255 |
Early Childhood Equity Grant Application |
English (Word)
|
|
14-281 |
Source of Funds Application for Child in Placement |
English (Word)
English (PDF)
|
|
14-293 |
Title IV-E Initial Eligibility Determination Income Calculation Worksheet |
English (Word)
English (PDF)
|
|
14-319 |
IV-E Eligibility Determination for an Adoption Support Application |
English (Word)
English (PDF)
|
|
14-319A |
IV-E Eligibility Determination for Federal Funds for GAP, Guardianship Assistance Program |
English (Word)
English (PDF)
|
|
14-417 |
CCSP Application |
English (Word)
Albanian (PDF)
Amharic (PDF)
Chinese (PDF)
Dari (PDF)
French (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)
|
|
14-417A |
Family, Friend, and Neighbor (FFN) In-Home/Relative Pending Letter |
English (Word)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Dari (PDF)
Farsi (PDF)
Nepali (PDF)
Oromo (PDF)
Romanian (PDF)
Russian (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Swahili (PDF)
Ukranian (PDF)
Vietnamese (PDF)
|
|
14-430 |
CCSP Child Care Reapplication |
English (Word)
Albanian (PDF)
Arabic (PDF)
Cambodian (PDF)
Chamarro (PDF)
Chinese (PDF)
Dari (PDF)
Farsi (PDF)
French (PDF)
Haitian-Creole (PDF)
Hindi (PDF)
Italian (PDF)
Korean (PDF)
Oromo (PDF)
Pashtu (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Swahili (PDF)
Thai (PDF)
Tigringa (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
14-434 |
Title IV-E Requirements for Out of State Foster Care Payments |
English (Word)
English (PDF)
|
|
14-435 |
Provider Employment Eligibility Verification |
English (Word)
English (PDF)
|
|
14-438 |
Stop Work |
English (Word)
Amharic (PDF)
Arabic (PDF)
Chinese (PDF)
Dari (PDF)
Oromo (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
14-444 |
Child Health and Education Tracking Screening Report |
English (Word)
Mam (PDF)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
14-446 |
Declaration of Financial Status for Adoption Support Application |
English (Word)
English (PDF)
|
|
14-452 |
Financial Worksheet |
English (Word)
English (PDF)
Marshallese (PDF)
Oromo (PDF)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
Tagalog (PDF)
Vietnamese (PDF)
|
|
14-474 |
Shared Planning Meeting |
English (Word)
Spanish (Word)
Spanish (PDF)
Cambodian (PDF)
Chinese (PDF)
Korean (PDF)
Mandinka (PDF)
Russian (PDF)
Somali (PDF)
Swahili (PDF)
Thai (PDF)
Tigrinya (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
14-510 |
Certified Respite Provider Agreements |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
14-512 |
Application for Certified Respite Provider |
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
14-531 |
Education and Training Voucher (ETV) Program and Passport to Careers Program 2023 – 2024 Application |
English (Word)
English (PDF)
|
|
14-531A |
Education and Training Voucher (ETV) Program and Passport to Careers Program Application Consent |
English (Word)
English (PDF)
|
|
14-545 |
Extended Adoption Support Application |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
14-548 |
Independent (IL) / Transitional Living (TL) Grant Application |
English (Word)
English (PDF)
|
|
14-600 |
Interim Individualized Family Service Plans (IFSP) (ESIT) |
English (Word)
|
|
15-005 |
ESIT Health Care Referral Form |
English (Word)
English (PDF)
|
|
15-015 |
Child Care Subsidy Program Site Change Form |
English (Word)
English (PDF)
|
|
15-016 |
HVSA Local Implementing Agency Contact Update Form |
English (Word)
English (PDF)
|
|
15-027 |
Professional Services Referral |
English (Word)
English (PDF)
|
|
15-028 |
Psychological Services Referral |
English (Word)
English (PDF)
|
|
15-029 |
Psychiatric Services Referral |
English (Word)
English (PDF)
|
|
15-030 |
SUS Residential Referral Form |
English (Word)
English (PDF)
|
|
15-050 |
Confirmation of Individualized Family Service Plan (IFSP) Schedule |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-051 |
Declining One or More Early Intervention Services |
English
Amharic (PDF)
Arabic
Cambodian
Chinese
Farsi
Korean
Laotian
Punjabi (PDF)
Russian
Somali
Spanish
Tamil
Telugu (PDF)
Ukrainian (PDF)
Urdu
Vietnamese
|
|
15-052 |
Declining Participation in the ESIT Program |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-053 |
Formal Dispute Resolution Request |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Laotian (PDF)
Marshallese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-054 |
Notice and Consent for Evaluation/Assessment |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-055 |
Individualized Family Service Plan (IFSP) |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Telugu (PDF)
Tamil (PDF)
Ukranina (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-056 |
Notice of Consent for Initial Evaluation Assessment |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Laotian (PDF)
Mashallese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telegu (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-057 |
Notice and Consent for Screening |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-058 |
Parent Prior Written Notice |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
15-059 |
Prior Written Notice Consent and Financial Information Forms |
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese
|
|
15-060 |
Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report |
English (Word)
|
|
15-092 |
The Interstate Compact on the Placement of Children (ICPC) Placement Request |
English (Word)
English (PDF)
|
|
15-093 |
Interstate Compact on the Placement of Children (ICPC) Report on Child’s Placement Date or Change of Placement – 100B |
English (Word)
English (PDF)
|
|
15-209A |
Health/Mental Health and Education Summary |
English (Word)
English (PDF)
|
|
15-209C |
Visit Plan |
English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tagalog (PDF)
Tigrigna (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
15-245 |
LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-258 |
Safety Assessment / Safety Plan Combined |
English (Word)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-258A |
Safety Assessment |
English (Word)
|
|
15-258B |
Safety Plan |
English (Word)
|
|
15-259A |
Case Plan |
English (Word)
English (PDF)
Chinese (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
15-260 |
Parents Information Sheet for Shared Planning Meetings and Staffings |
English (Word)
English (PDF)
|
|
15-266 |
Child Protect Teams (CPT) Staffing Recommendations |
English (Word)
English (PDF)
|
|
15-267 |
Attendance and Confidentiality Agreement |
English (Word)
English (PDF)
Vietnamese (PDF)
|
|
15-268 |
Child Protect Teams (CPT) Case Presentation Summary |
English (Word)
English (PDF)
|
|
15-276 |
Personal Information |
English (WORD)
Marshallese (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tagalog (PDF)
Tigrigna (PDF)
|
|
15-280 |
Unlicensed Caregiver Placement Checklist |
English (Word)
English (PDF)
|
|
15-281 |
Placement Agreement |
English (Word)
Arabic (PDF)
Chinese (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-286 |
Reference Questionnaire |
English (Word)
English (PDF)
Arabic (PDF)
Marhsallese (PDF)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Tagalog (PDF)
|
|
15-286A |
Adult Child Reference Questionnaire |
English (Word)
English (PDF)
Arabic (PDF)
Marshallese (PDF)
Spanish (PDF)
Tagalog (PDF)
|
|
15-300 |
Child Information and Placement Referral |
English (Word)
English (PDF)
|
|
15-308 |
Missing Child Staffing |
English (Word)
English (PDF)
|
|
15-309 |
Returning Child De-Briefing |
English (Word)
English (PDF)
|
|
15-313 |
Caregiver's Report to the Court |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-313A |
Caregiver's Report to the Court (Abbreviated) |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-322 |
Long Term Care Agreement for Foster Parents or Relative Caregivers |
English (Word)
English (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-324 |
Guardianship Approval Checklist |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-349a |
Kinship Respite Overcapacity WAC 110-148-1390 |
English (Word)
|
|
15-359 |
Child's Physical Description |
English (Word)
English (PDF)
|
|
15-362 |
Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home |
English (Word)
English (PDF)
|
|
15-363B |
Provider Notification of Visit/Transport Schedule Initial Intake Screening Report |
English (Word)
English (PDF)
|
|
15-363C |
Visit Coordination Plan |
English (Word)
English (PDF)
|
|
15-368 |
Education and Training Voucher (ETV) Program Participation Agreement |
English (Word)
English (PDF)
|
|
15-368A |
Education and Training Voucher (ETV) Program Dual Credit Participation Agreement |
English (PDF)
English (Word)
|
|
15-369 |
Education and Training Voucher (ETV) Program 2023 - 2024 Renewal Application |
English (Word)
English (PDF)
|
|
15-370 |
Education and Training Voucher (ETV) Program Payment Request |
English (Word)
English (PDF)
|
|
15-372 |
Enumeration Referral |
English (Word)
English (PDF)
|
|
15-377 |
Education and Training Voucher (ETV) Program Dual Credit Application |
English (Word)
|
|
15-402 |
Notice to Foreign Consulate of Child Protection Proceedings |
English (Word)
English (PDF)
|
|
15-411A |
Licensing Waiver (Foster Home) |
English (Word)
|
|
15-411D |
Administrative Approval (Foster Home) |
English (Word)
|
|
15-411G |
Kinship License Non-Safety Exemption/Waiver (Licensed Home) |
15-411G.docx
|
|
15-412 |
Request for Extension and Disability Verification for Youth Over Age 18 |
English (Word)
English (PDF)
|
|
15-416 |
Interstate Compact for Adoption Medical Assstance ICAMA |
English (Word)
|
|
15-417 |
Transition Plan for Youth Exiting Care |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-425 |
Adoption Redaction Request |
English (Word)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
|
|
15-428 |
Protective Action Plan |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Cambodian (PDF)
Chinese (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Vietnamese (PDF)
|
|
15-431 |
Extended Foster Care Program Voluntary Placement Agreement (VPA) |
English (Word)
English (PDF)
Dari (PDF)
French (PDF)
Spanish (PDF)
Spanish (Word)
|
|
15-434 |
On-Going Mental Health (OMH) Screening Report |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-448 |
Family Time Report |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-448A |
Supported Visit Report |
English (Word)
English (PDF)
|
|
15-450 |
Child Specific Caregiver Notification |
English (Word)
English (PDF)
|
|
15-451 |
Missed and No Show Report: Parent – Child Visit |
English (Word)
English (PDF)
|
|
15-452 |
Sibling Visit Report |
English (Word)
English (PDF)
|
|
15-454 |
Unusual Incident Report |
English (Word)
|
|
15-455 |
Vaccine Exemption |
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
15-460 |
Background Confirmation and Out of State Check |
English (Word)
Farsi (PDF)
Marshallese (PDF)
Spanish (PDF)
Spanish (Word)
Russian (PDF)
Tigrigna (PDF)
|
|
15-466 |
Contract Risk Assessment / Analysis |
English (PDF)
|
|
15-469 |
Pre-Contract Action Request (P-CAR) |
English (Word)
English (PDF)
|
|
15-470 |
DCYF Regional Contract Request |
English (Word)
English (PDF)
|
|
15-472 |
After-the-Fact Contract Justification |
English (Word)
|
|
15-491 |
Plan of Safe Care |
English (Word)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Korean (PDF)
Laotian (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)
|
|
15-703 |
Declaration of Compliance (for Outdoor Nature-Based Programs) |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-705 |
FFN Waiver Request |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-707 |
School-Age Child Care Monitoring Checklist |
English (Word)
English (PDF)
|
|
15-708 |
Child Care Center Monitoring Checklist (Example) |
English (Word)
|
|
15-709 |
Family Home Child Care Monitoring Checklist (Example) |
English (Word)
|
|
15-716 |
Benefit-Risk Assessment and Mitigation Development for Outdoor Nature-Based (ONB) Child Care Programs |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-720 |
Interest Survey for Organization License Pilot |
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
15-820 |
Tuberculosis (TB) Screening LD |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
15-821 |
Infant Safety Agreement |
English (Word)
Marshellese (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
15-821a |
Infant Safety Certified Respite |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-822 |
Influenza Vaccination Agreement |
English (Word)
Somali (PDF)
Spanish (Word)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
15-822a |
Vaccine Agreements Certified Respite |
English (Word)
English (Word)
Spanish (Word)
Spanish (fillable PDF)
|
|
15-823 |
Pertussis Vaccination Agreement |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
|
|
15-824 |
Authorization and Consent to Share Records |
English (Word)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
15-824A |
Authorization and Consent to Share Records (CPA Home) |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-824b |
Authorization and Consent to Share Records (Child Placing Agency/Group Care Staff) |
English (Word)
English (PDF)
|
|
15-825 |
Date of 16th or 18th Birthday |
English (Word)
English (PDF)
|
|
15-826 |
Pet Vaccination Agreement |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
15-827 |
Kinship Caregiver iPad Equipment Checkout Agreement |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
15-835 |
Outdoor Nature-Based Child Care License or Certification Application |
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
15-841 |
ONB Initial Checklist for Applicant |
English (Word)
|
|
15-845 |
ONB Monitoring Checklist (Example) |
English (Word)
|
|
15-852 |
Plan to Meet Experience Qualification |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-853 |
Intent to Transfer License or Certification |
English (Word)
English (PDF)
Somali (Word)
Somali (fillable PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
15-857 |
Parent/Provider Health Safety Agreement (FFN) |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-858 |
Emergency Contact and Permission Form (FFN) |
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
15-859 |
Safety Record and Evacuation Plan |
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
15-860 |
Medication Permission Form For Illness and Allergies (FFN) |
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
15-861 |
Initial Checklist for Child Care Center Applicant |
English (Word)
|
|
15-862 |
Initial Checklist for Family Home Child Care Applicant |
English (Word)
|
|
15-863 |
Initial Checklist for School-Age Program Applicant |
English (Word)
|
|
15-874 |
Capacity Increase Change Planning Guide |
English (Word)
English (PDF)
|
|
15-879 |
Child Care Registration (fh/ctr) |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-891 |
Chimney, Fireplace, Woodstove Use Statement |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-892 |
Fire, Safety, Emergency Drills Record |
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
15-893 |
Multiple Licenses Request Form |
English (Word)
|
|
15-894 |
Family Home Child Care Liability Insurance Form |
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish PDF)
|
|
15-895 |
Overnight Child Care Planning Guide |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-896 |
Probation Notification Letter to Parents from Provider |
English (Word)
|
|
15-897 |
Child Care Parent Guardian Permissions |
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
15-899 |
Child Licensee or Assistant Resume |
English (Word)
English PDF)
Somali (PDF)
|
|
15-937 |
Child Care Center School-Age Background Checklist |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
15-941 |
Child Care Injury Incident Report |
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Spanish (Word)
|
|
15-942 |
Daily Child Attendance Records |
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-943 |
Child Care Agreement |
English (Word)
Spanish (Word)
|
|
15-944 |
School Based and Military Certification for Payment Only Request |
English (Word)
|
|
15-945 |
Tribal Certification Request |
English (Word)
|
|
15-949 |
Family Home Child Care Background Checklist |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-952 |
Notification to Parents and Guardian - Safe Sleep Non-Compliance |
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-954 |
Notification of Staffing Plan Absence |
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
15-955 |
Family Home and Center Child Care License or Certification Application |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
15-956 |
No Social Security Card Declaration |
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
15-957 |
Child Care Variance Request |
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
15-961 |
Child Care Waiver Request |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-963 |
Early Learning-Child Care Facility Feasibility Checklist |
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
15-964 |
Early Learning-Child Care Facility Feasibility Checklist (sa) |
English (Word)
|
|
15-965 |
Sanitizer Disinfectant Approval Request |
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
15-966 |
Child Care Health Consultant Agreement |
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-967 |
Child Care Health Consultant Onsite Report |
English (Word)
Engllish (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-968 |
Child Care Medication Authorization |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
15-969 |
Child Care Medication Log |
Englislh (Word)
Somali (PDF)
Spanish (PDF)
|
|
15-970 |
Individual Care Plan for Child in Child Care |
English (Word)
English (PDF)
Spanish (PDF)
|
|
15-974 |
Declaration of Compliance |
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
15-980 |
School Age License Application |
English (Word)
English (PDF)
|
|
16-005 |
Electronice Attendance Provider Welcome Letter (Barcode) |
English (Word)
English (PDF)
|
|
16-010 |
Parental Advisory Group (PAG) Cover Letter and Application |
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
Spanish (Word)
|
|
16-015 |
State Approved Training Concern Form |
English (Word)
English (PDF)
|
|
16-025 |
Contractor Certification |
English (Word)
|
|
16-030 |
Book Review Worksheet for Foster Parent Training Hours |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
16-179 |
Reference Questionnaire Request |
English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
16-204 |
Emergency and Evacuation Plan |
English (Word)
Marshallese (PDF)
Samoan (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
|
|
16-209 |
Archived Records Memo Adoption and/or Legally Free Children Aged Out |
English (Word)
English (PDF)
|
|
16-217 |
Washington State ICPC Quarterly Supervision Report |
English (Word)
English (PDF)
|
|
16-225 |
File Checklist (Certified Respite) |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
16-235 |
Photo, Video or Audio Release Waiver |
English (PDF)
Chinese (PDF)
Somali (PDF)
Spanish (PDF)
|
|
17-041A |
Request for DCYF Records |
English (Word)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
17-063 |
Written Authorization |
English (Word)
English (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
17-215 |
DCYF Checklist: Subcontractor Approval Request |
English (Word)
English (PDF)
|
|
17-215A |
DCYF Checklist: Subcontractor Approval Request |
English (Word)
English (PDF)
|
|
17-251 |
FERPA Access Request |
English (Word)
English (PDF)
|
|
18-400 |
Foster Caregiver Reimbursement Claim |
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
18-400A |
Foster Caregiver Third Party Liability Claim |
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
19-015 |
Workforce Retention Grant Verification Form |
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
20-015 |
Juvenile Rehabilitation Youth Engagement Request |
English (Word)
|
|
20-016 |
JR Marriage Approval for Release of Information |
English (Word)
English (PDF)
|
|
20-017 |
JR Marriage Application |
English (Word)
English (PDF)
|
|
20-020 |
Acknowledgement of JR Policy 6.70 Marriage in JR Facilities |
English (Word)
English (PDF)
|
|
20-270 |
Juvenile Justice System Improvement Technical Assistance Grant Application |
English (Word)
|
|
23-005 |
Three Pronged Approach (TPA) I. Parent Interview Questions Related to Vision and Hearing |
English (Word)
Spanish (fillable PDF)
|
|
23-006 |
Three-Pronged Approach (TPA) Developmental Skills Checklist Related to Vision and Hearing in Young Children |
English (PDF)
Spanish (fillable PDF)
|
|
23-007 |
Three-Pronged Approach (TPA) Summary Form Addressing Vision and Hearing Concerns |
English (PDF)
Amharic (fillable PDF)
Arabic (fillable PDF)
Bengali (fillable PDF)
Cambodian (fillable PDF)
Chinese (fillable PDF)
Chinese Traditional (fillable PDF)
Dari (fillable PDF)
Farsi (fillable PDF)
French (fillable PDF)
Hindi (fillable PDF)
Japanese (fillable PDF)
Nepali (fillable PDF)
Pashtu (fillable PDF)
Portuguese (fillable PDF)
Punjabi (fillable PDF)
Russian (fillable PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
Tagalog (fillable PDF)
Telugu (fillable PDF)
Tamil (fillable PDF)
Tigrigna (fillablePDF)
Vietnamese (fillable PDF)
|
|
23-032 |
In-State Child Abuse and Neglect Founded Findings Request |
English (Word)
English (PDF)
|
|
23-033 |
Child Abuse and Neglect Information Request |
English (Word)
English (PDF)
|
|
23-035 |
CHINS/ARY Report to Juvenile Court |
English (Word)
English (PDF)
|
|
23-036 |
Child Placing Agency Foster Home Licensing Investigation |
English (Word)
|
|
23-036A |
Child Placing Agency Foster Home Licensing Investigation Interviews |
English (Word)
English (PDF)
|
|
23-037 |
Background Clearance Notification |
English (Word)
|
|
23-041 |
Washington State Child Abuse and Neglect Founded Findings Request from Another State |
English (Word)
English (PDF)
|
|
23-046 |
ECEAP Program Monitoring Community Partner Questionnaire |
English (Word)
English (PDF)
|
|
27-164 |
Single Parent Declaration |
English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Chamarro (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Lingala (PDF)
Marshallese (PDF)
Oromo (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Swahili (PDF)
Tigrinya (PDF)
Trukese (PDF)
Portugese (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
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