Department of Children, Youth & Families

Number Sort ascending	Form Name	Revision Date	File Format
27-164	Single Parent Declaration	09-2020	English (Word) English (PDF) Albanian (PDF) Amharic (PDF) Arabic (PDF) Chamarro (PDF) Chinese (PDF) Farsi (PDF) Fijan (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)
23-046	ECEAP Program Monitoring Community Partner Questionnaire		English (Word) English (PDF)
23-041	Washington State Child Abuse and Neglect Founded Findings Request from Another State		English (Word) English (PDF)
23-037	Background Clearance Notification		English (Word)
23-036	Child Placing Agency Foster Home Licensing Investigation		English (Word)
23-035	CHINS/ARY Report to Juvenile Court		English (Word) English (PDF)
23-033	Child Abuse and Neglect Information Request		English (Word) English (PDF)
23-032	In-State Child Abuse and Neglect Founded Findings Request		English (Word) English (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)
23-006	Three-Pronged Approach (TPA) Developmental Skills Checklist Related to Vision and Hearing in Young Children		English (PDF) Spanish (fillable PDF)
23-005	Three Pronged Approach (TPA) I. Parent Interview Questions Related to Vision and Hearing		English (Word) Spanish (fillable PDF)
20-270	Juvenile Justice System Improvement Technical Assistance Grant Application		English (Word)
20-020	Acknowledgement of JR Policy 6.70 Marriage in JR Facilities		English (Word) English (PDF)
20-017	JR Marriage Application		English (Word) English (PDF)
20-016	JR Marriage Approval for Release of Information		English (Word) English (PDF)
20-015	Juvenile Rehabilitation Youth Engagement Request		English (Word)
19-015	Workforce Retention Grant Verification Form		English (Word) Spanish (Word) Spanish (PDF) Somali (PDF)
18-400A	Foster Caregiver Third Party Liability Claim		English (Word) English (PDF) Spanish (Word) Spanish (fillable PDF)
18-400	Foster Caregiver Reimbursement Claim		English (Word) English (PDF) Spanish (Word) Spanish (fillable PDF)
17-251	FERPA Access Request		English (Word) English (PDF)
17-215A	DCYF Checklist: Subcontractor Approval Request		English (Word) English (PDF)
17-215	DCYF Checklist: Subcontractor Approval Request		English (Word) English (PDF)
17-063	Written Authorization		English (Word) English (PDF) Vietnamese (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Spanish (Word) Vietnamese (PDF)
17-041A	Request for DCYF Records	02-2024	English (Word) English (PDF)
16-235	Photo, Video or Audio Release Waiver		English (PDF) Chinese (PDF) Somali (PDF) Spanish (PDF)
16-225	File Checklist (Certified Respite)		English (Word) Spanish (Word) Spanish (PDF)
16-217	Washington State ICPC Quarterly Supervision Report		English (Word) English (PDF)
16-209	Archived Records Memo Adoption and/or Legally Free Children Aged Out		English (Word) English (PDF)
16-204	Emergency and Evacuation Plan	01-2023	English (Word) Marshallese (PDF) Samoan (PDF) Soninke (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF) Trukese (PDF)
16-190	Overnight Youth Shelter Checklist	01-2019	English (Word)
16-189	Group Home Checklist	01-2019	English (Word)
16-188	Medically Fragile and Children with Intellectual and Developmental Disabilities Checklist	01-2019	English (Word)
16-186	Crisis & Secured Crisis Residential Checklist	01-2019	English (Word)
16-184	Maternity Services Checklist	01-2019	English (Word)
16-183	Emergency Respite Center Checklist	01-2019	English (Word)
16-179	Reference Questionnaire Request		English (Word) Marshallese (PDF) Spanish (Word) Spanish (PDF)
16-030	Book Review Worksheet for Foster Parent Training Hours		English (Word) Spanish (Word) Spanish (PDF)
16-025	Contractor Certification		English (Word)
16-015	State Approved Training Concern Form		English (Word) English (PDF)
16-010	Parental Advisory Group (PAG) Cover Letter and Application		English (Word) Somali (fillable PDF) Spanish (fillable PDF) Spanish (Word)
16-005	Electronice Attendance Provider Welcome Letter (Barcode)		English (Word) English (PDF)
15-980	School Age License Application	01-2024	English (Word) English (PDF)
15-974	Declaration of Compliance	12-2023	English (PDF) Somali (fillable PDF) Spanish (fillable PDF)
15-970	Individual Care Plan for Child in Child Care		English (Word) English (PDF) Spanish (PDF)
15-969	Child Care Medication Log		Englislh (Word) Somali (PDF) Spanish (PDF)
15-968	Child Care Medication Authorization		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-967	Child Care Health Consultant Onsite Report		English (Word) Engllish (PDF) Somali (PDF) Spanish (PDF)
15-966	Child Care Health Consultant Agreement		Engllish (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-965	Sanitizer Disinfectant Approval Request		English (Word) Somali (PDF) Spanish (PDF) Spanish (Word)
15-964	Early Learning-Child Care Facility Feasibility Checklist (sa)		English (Word)
15-963	Early Learning-Child Care Facility Feasibility Checklist		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
15-961	Child Care Waiver Request		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-957	Child Care Variance Request		English (Word) Somali (PDF) Spanish (PDF)
15-956	No Social Security Card Declaration		English (Word) Somali (PDF) Spanish (PDF)
15-955	Family Home and Center Child Care License or Certification Application	01-2024	English (Word) English (PDF) Somali (PDF) Spanish (PDF) Spanish (Word)
15-954	Notification of Staffing Plan Absence		English (Word) Somali (PDF) Spanish (PDF)
15-952	Notification to Parents and Guardian - Safe Sleep Non-Compliance		English (PDF) Somali (PDF) Spanish (PDF)
15-949	Family Home Child Care Background Checklist	09-2023	English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-945	Tribal Certification Request		English (Word)
15-944	School Based and Military Certification for Payment Only Request		English (Word)
15-943	Child Care Agreement		English (Word) Spanish (Word)
15-942	Daily Child Attendance Records		English (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF)
15-941	Child Care Injury Incident Report		Engllish (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF) Spanish (Word)
15-937	Child Care Center School-Age Background Checklist	01-2024	English (Word) English (PDF) Somali (PDF) Spanish (PDF) Spanish (Word)
15-899	Child Licensee or Assistant Resume		English (Word) English PDF) Somali (PDF)
15-897	Child Care Parent Guardian Permissions		English (Word) English (PDF) Somali (Word) Spanish (Word)
15-896	Probation Notification Letter to Parents from Provider		English (Word)
15-895	Overnight Child Care Planning Guide		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-894	Family Home Child Care Liability Insurance Form		Engllish (Word) English (PDF) Somali (PDF) Spanish PDF)
15-893	Multiple Licenses Request Form		English (Word)
15-892	Fire, Safety, Emergency Drills Record		English (Word) Somali (PDF) Spanish (PDF)
15-891	Chimney, Fireplace, Woodstove Use Statement		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-889	Sample Application for Employment or Volunteer Services Licensed or Certified Early Learning/Child Care Program		English (Word) English (PDF)
15-879	Child Care Registration (fh/ctr)		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-874	Capacity Increase Change Planning Guide		English (Word) English (PDF)
15-863	Initial Checklist for School-Age Program Applicant	05-2023	English (Word)
15-862	Initial Checklist for Family Home Child Care Applicant	05-2023	English (Word)
15-861	Initial Checklist for Child Care Center Applicant	05-2023	English (Word)
15-860	Medication Permission Form For Illness and Allergies (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)
15-858	Emergency Contact and Permission Form (FFN)		English (Word) Somali (fillable PDF) Spanish (fillable PDF)
15-857	Parent/Provider Health Safety Agreement (FFN)		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)
15-852	Plan to Meet Experience Qualification		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-845	ONB Monitoring Checklist (Example)		English (Word)
15-841	ONB Initial Checklist for Applicant		English (Word)
15-835	Outdoor Nature-Based Child Care License or Certification Application	01-2024	English (Word) Spanish (Word) Spanish (PDF) Somali (PDF)
15-827	Kinship Caregiver iPad Equipment Checkout Agreement		English (Word) Spanish (Word) Spanish (PDF)
15-826	Pet Vaccination Agreement	06-2023	English (Word) English (PDF) Maay Maay (PDF) Soninke (PDF) Spanish (PDF) Spanish (Word) Trukese (PDF)
15-824b	Authorization and Consent to Share Records (Child Placing Agency/Group Care Staff)		English (Word) English (PDF)
15-824A	Authorization and Consent to Share Records (CPA Home)		English (Word) English (PDF) Spanish (Word) Spanish (PDF)
15-824	Authorization and Consent to Share Records		English (Word) Spanish (Word) Spanish (PDF) Trukese (PDF) Vietnamese (PDF)
15-823	Pertussis Vaccination Agreement		English (Word) English (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF)
15-822a	Vaccine Agreements Certified Respite		English (Word) English (Word) Spanish (Word) Spanish (fillable PDF)
15-822	Influenza Vaccination Agreement	09-2022	English (Word) Somali (PDF) Soninke (PDF) Spanish (Word) Tigrigna (PDF) Vietnamese (PDF)
15-821a	Infant Safety Certified Respite		English (Word) Spanish (Word) Spanish (PDF)
15-821	Infant Safety Agreement		English (Word) Marshellese (PDF) Somali (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF) Vietnamese (PDF)
15-820	Tuberculosis (TB) Screening LD	06-2023	English (Word) English (PDF) Soninke (PDF) Spanish (PDF) Spanish (Word) Trukese (PDF)
15-720	Interest Survey for Organization License Pilot		English (Word) English (PDF) Somali (fillable PDF) Spanish (fillable PDF)
15-716	Benefit-Risk Assessment and Mitigation Development for Outdoor Nature-Based (ONB) Child Care Programs		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
15-709	Family Home Child Care Monitoring Checklist (Example)		English (Word)
15-708	Child Care Center Monitoring Checklist (Example)		English (Word)
15-707	School-Age Child Care Monitoring Checklist		English (Word) English (PDF)
15-705	FFN Waiver Request		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
15-703	Declaration of Compliance (for Outdoor Nature-Based Programs)		English (Word) Spanish (Word) Spanish (PDF)
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)
15-489	Placement Entry Tool		English (Word) English (PDF)
15-472	After-the-Fact Contract Justification		English (Word)
15-470	DCYF Regional Contract Request		English (Word) English (PDF)
15-469	Pre-Contract Action Request (P-CAR)		English (Word) English (PDF)
15-466	Contract Risk Assessment / Analysis		English (PDF)
15-460	Background Confirmation and Out of State Check	03-2024	English (Word)
15-455	Vaccine Exemption		English (Word) English (PDF) Spanish (Word) Spanish (fillable PDF)
15-454	Unusual Incident Report		English (Word)
15-452	Sibling Visit Report		English (Word) English (PDF)
15-451	Missed and No Show Report: Parent – Child Visit		English (Word) English (PDF)
15-450	Child Specific Caregiver Notification		English (Word) English (PDF)
15-448A	Supported Visit Report		English (Word) English (PDF)
15-448	Family Time Report		English (Word) Spanish (Word) Spanish (PDF)
15-434	On-Going Mental Health (OMH) Screening Report		English (Word) Spanish (Word) Spanish (PDF)
15-431	Extended Foster Care Program Voluntary Placement Agreement (VPA)		English (Word) English (PDF) Dari (PDF) French (PDF) Spanish (PDF) Spanish (Word)
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)
15-425	Adoption Redaction Request		English (Word) English (PDF) Spanish (Word) Somali (PDF) Spanish (PDF) Ukrainian (PDF) Vietnamese (PDF)
15-417	Transition Plan for Youth Exiting Care		English (Word) English (PDF) Spanish (Word) Spanish (PDF)
15-416	Interstate Compact for Adoption Medical Assstance ICAMA		English (Word)
15-412	Request for Extension and Disability Verification for Youth Over Age 18		English (Word) English (PDF)
15-411G	Kinship License Non-Safety Exemption/Waiver (Licensed Home)		15-411G.docx
15-411D	Administrative Approval (Foster Home)		English (Word)
15-411A	Licensing Waiver (Foster Home)		English (Word)
15-402	Notice to Foreign Consulate of Child Protection Proceedings		English (Word) English (PDF)
15-386	Independent Living Learning Plan and Progress Report - IL Provider	02-2024	English (Word)
15-377	Education and Training Voucher (ETV) Program Dual Credit Application		English (Word)
15-372	Enumeration Referral		English (Word) English (PDF)
15-370	Education and Training Voucher (ETV) Program Payment Request		English (Word) English (PDF)
15-369	Education and Training Voucher (ETV) Program 2024 - 2025 Renewal Application	08-2023	English (Word)
15-368A	Education and Training Voucher (ETV) Program Dual Credit Participation Agreement		English (PDF) English (Word)
15-368	Education and Training Voucher (ETV) Program Participation Agreement		English (Word) English (PDF)
15-363C	Visit Coordination Plan		English (Word) English (PDF)
15-363B	Provider Notification of Visit/Transport Schedule Initial Intake Screening Report		English (Word) English (PDF)
15-362	Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home		English (Word) English (PDF)
15-359	Child's Physical Description		English (Word) English (PDF)
15-349a	Kinship Respite Overcapacity WAC 110-148-1390		English (Word)
15-324	Guardianship Approval Checklist		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)
15-313A	Caregiver's Report to the Court (Abbreviated)		English (Word) Spanish (Word) Spanish (PDF)
15-313	Caregiver's Report to the Court	06-2023	English (Word) Spanish (Word) Spanish (PDF)
15-309	Returning Child De-Briefing		English (Word) English (PDF)
15-308	Missing Child Staffing		English (Word) English (PDF)
15-300	Child Information and Placement Referral		English (Word) English (PDF)
15-286A	Adult Child Reference Questionnaire		English (Word) English (PDF) Arabic (PDF) Marshallese (PDF) Spanish (PDF) Tagalog (PDF)
15-286	Reference Questionnaire	01-2023	English (Word) English (PDF) Arabic (PDF) Marhsallese (PDF) Russian (PDF) Spanish (Word) Somali (PDF) Spanish (PDF) Tagalog (PDF) Vietnamese (PDF)
15-281	Placement Agreement	07-2023	English (Word) Arabic (PDF) Chinese (PDF) Russian (PDF) Somali (PDF) Soninke (PDF) Spanish (Word) Spanish (PDF)
15-280	Unlicensed Caregiver Placement Checklist	06-2023	English (Word) English (PDF) Spanish (Word) Spanish (PDF)
15-276	Personal Information		English (WORD) Marshallese (PDF) Samoan (PDF) Somali (PDF) Spanish (PDF) Spanish (Word) Tagalog (PDF) Tigrigna (PDF) Trukese (PDF)
15-268	Child Protect Teams (CPT) Case Presentation Summary		English (Word) English (PDF)
15-267	Attendance and Confidentiality Agreement		English (Word) English (PDF) Vietnamese (PDF)
15-266	Child Protect Teams (CPT) Staffing Recommendations		English (Word) English (PDF)
15-260	Parents Information Sheet for Shared Planning Meetings and Staffings		English (Word) English (PDF)
15-259A	Case Plan		English (Word) English (PDF) Chinese (PDF) Korean (PDF) Pashtu (PDF) Russian (PDF) Somali (PDF) Spanish (Word) Spanish (PDF) Vietnamese (PDF)
15-258B	Safety Plan	05-2023	English (Word) Spanish (Word) Spanish (PDF)
15-258A	Safety Assessment		English (Word)
15-258	Safety Assessment / Safety Plan Combined	05-2023	English (Word) Haitian-Creole (PDF) Russian (PDF) Somali (PDF) Spanish (Word) Trukese (PDF) Trukese (PDF)
15-245	LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record		English (Word) English (PDF) Spanish (Word) Spanish (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)
15-209A	Health/Mental Health and Education Summary		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)
15-092	The Interstate Compact on the Placement of Children (ICPC) Placement Request		English (Word) English (PDF)
15-060	Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report		English (Word)
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) Portuguese (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Tamil (PDF) Telugu (PDF) Ukrainian (PDF) Urdu (PDF) Vietnamese
15-058	Parent Prior Written Notice	01-2019	English (PDF) Amharic (PDF) Arabic (PDF) Cambodian (PDF) Chinese (PDF) Farsi (PDF) Korean (PDF) Laotian (PDF) Portuguese (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Tamil (PDF) Telugu (PDF) Ukrainian (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)
15-056	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) Portuguese (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Tamil (PDF) Telegu (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)
15-054	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)
15-053	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)
15-052	Declining Participation in the ESIT Program		English (PDF) Amharic (PDF) Arabic (PDF) Cambodian (PDF) Chinese (PDF) Farsi (PDF) Korean (PDF) Laotian (PDF) Portuguese (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
15-050	Confirmation of Individualized Family Service Plan (IFSP) Schedule		English (PDF) Amharic (PDF) Arabic (PDF) Cambodian (PDF) Chinese (PDF) Farsi (PDF) Korean (PDF) Laotian (PDF) Portuguese (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Tamil (PDF) Telugu (PDF) Ukrainian (PDF) Urdu (PDF) Vietnamese (PDF)
15-030	Substance Use Disorder Professional (SUDP) Referral	04-2024	English (Word)
15-029	Psychiatric Services Referral		English (Word) English (PDF)
15-028	Psychological Services Referral		English (Word) English (PDF)
15-027	Professional Services Referral		English (Word) English (PDF)
15-016	HVSA Local Implementing Agency Contact Update Form		English (Word) English (PDF)
15-015	Child Care Subsidy Program Site Change Form		English (Word) English (PDF)
15-005	ESIT Health Care Referral Form		English (Word) English (PDF)
14-600	Interim Individualized Family Service Plans (IFSP) (ESIT)		English (Word)
14-548	Independent (IL) / Transitional Living (TL) Grant Application		English (Word) English (PDF)
14-545	Extended Adoption Support Application		English (Word) English (PDF) Spanish (Word) Spanish (PDF)
14-531A	Education and Training Voucher (ETV) Program and Passport to Careers Program Application Consent		English (Word) English (PDF)
14-531	Education and Training Voucher (ETV) Program and Passport to Careers Program 2024 – 2025 Application	08-2023	English (Word)
14-512	Application for Certified Respite Provider		English (Word) English (PDF) Spanish (Word) Spanish (fillable PDF)
14-510	Certified Respite Provider Agreements		English (Word) English (PDF) Spanish (PDF) Spanish (Word)
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)
14-452	Financial Worksheet	09-2022	English (Word) English (PDF) Marshallese (PDF) Oromo (PDF) Soninke (PDF) Spanish (Word) Spanish (PDF) Somali (PDF) Tagalog (PDF) Vietnamese (PDF)
14-446	Declaration of Financial Status for Adoption Support Application		English (Word) English (PDF)
14-444	Child Health and Education Tracking Screening Report	09-2023	English (Word) Spanish (Word) Spanish (PDF)
14-438	Stop Work		English (Word) Amharic (PDF) Arabic (PDF) Chinese (PDF) Dari (PDF) Oromo (PDF) Russian (PDF) Somali (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF) Trukese (PDF) Vietnamese (PDF)
14-435	Provider Employment Eligibility Verification		English (Word) English (PDF)
14-434	Title IV-E Requirements for Out of State Foster Care Payments		English (Word) English (PDF)
14-430	CCSP Child Care Reapplication	08-2022	English (Word) Albanian (PDF) Arabic (PDF) Cambodian (PDF) Chamarro (PDF) Chinese (PDF) Dari (PDF) Farsi (PDF) French (PDF) French (PDF) Haitian-Creole (PDF) Hindi (PDF) Italian (PDF) Korean (PDF) Lingala (PDF) Oromo (PDF) Pashtu (PDF) Portuguese (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Swahili (PDF) Thai (PDF) Tigringa (PDF) Ukrainian (PDF) Vietnamese (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)
14-319A	IV-E Eligibility Determination for Federal Funds for GAP, Guardianship Assistance Program		English (Word) English (PDF)
14-319	IV-E Eligibility Determination for an Adoption Support Application		English (Word) English (PDF)
14-293	Title IV-E Initial Eligibility Determination Income Calculation Worksheet		English (Word) English (PDF)
14-281	Source of Funds Application for Child in Placement		English (Word) English (PDF)
14-255	Early Childhood Equity Grant Application	02-2024	English (Word)
14-252	Employment Verification	08-2022	English (Word) English (PDF) Albanian (PDF) Amharic (PDF) Cambodian (PDF) Chinese (PDF) Dar (PDF) Farsi (PDF) French (PDF) Haitian-Creole (PDF) Korean (PDF) Lingala (PDF) Mongolian (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Swahili (PDF) Tagalog (PDF) Turkish (PDF) Ukaranian (PDF) Vietnamese (PDF)
14-224	Statement from Landlord/Manager	01-2023	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) Oromo (PDF) Portuguese (PDF) Punjabi (PDF) Romanian (PDF) Russian (PDF) Rwanda (PDF) Swahili (PDF) Somali (PDF) Soninke (PDF) Spanish (PDF) Tagalog (PDF) Tigrigna (PDF) Turkish (PDF) Trukese (PDF) Ukranian (PDF) Urdu (PDF) Vietnamese (PDF)
14-040	Non ECEAP Child Request for ECLIPSE Enrollment	02/2024	English (Word)
14-025	Early Achievers Extension Application		English (Word) Somali (Word) Spanish (Word)
14-012	Consent for Release of Information	05-2023	English (Word) Amharic (PDF) Arabic (PDF) Cambodian (PDF) Chinese (PDF) French (PDF) Laotian (PDF) Pashtu (PDF) Russian (PDF) Somali (PDF) Soninke (PDF) Spanish (PDF) Ukranian (PDF) Vietnamese (PDF)
14-011a	Change Form Medical and Dental Benefits		English (PDF) Spanish (fillable PDF) Somali (fillable PDF)
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)
14-005	OJJDP Title II Pass Through Fund		English (Word)
14-003	Trainer Observation Rubric (Self Paced)		English (Word)
14-002	Trainer Observation Rubric		English (Word) English (PDF)
14-001	Employment Verification for State Training	07-2021	English (Word) English (PDF) Spanish (Word) Spanish (PDF)
13-908	Brief Assessment of Anxiety and PTSD: Child / Youth (SCARED)	01-2024
13-907	Brief Assessment of Anxiety and PTSD: Caregiver/Parent		English (Word) English (PDF) Russian (PDF) Somali (PDF) Spanish (PDF)
13-904	Diabetes Care and Action Plan		English (Word) English (PDF)
13-200	Health & Safety Checklist		English (Word)
13-041	Family Genetic and Medical History		English (Word) English (PDF) Spanish (Word) Spanish (PDF) Vietnamese (PDF)
13-001B	Applicant Mental Health Report		English (Word) Spanish (PDF)
13-001A	Applicant Medical Self Report		English (Word) Marshallese (PDF) Oromo (PDF) Samoan (PDF) Somali (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF) Trukese (PDF) Vietnamese (PDF)
13-001	Applicant Medical Report- Confidential	09-2022	English (Word) Oromo (PDF) Samoan (PDF) Spanish (Word) Spanish (PDF) Somali (PDF) Soninke (PDF) Tagalog (PDF) Tigrigna (PDF) Vietnamese (PDF)
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) Lingala (PDF) Pashtu (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Tigrigna (PDF) Ukranian (PDF) Urdu (PDF) Vietnamese (PDF)
11-032	Strengthen Families Locally (SFL) Budget Templatae		English (Excel)
11-031	Strengthen Families Locally Priority Project Proposal		English (Word)
11-030	Youth and Young Adult Housing Response Team Referral		English (Word)
11-029	Quarterly Reporting Tool - Stengthen Families Locally		English (Excel)
11-028	Tribal Fatherhood Quarterly Reports	02-2024	English (Word)
11-027	Option 2		English (Excel)
11-026	Option 1B		English (Excel)
11-025	Option 1A		English (Excel)
11-024	Tribal Fatherhood Supports Project Plan		English (Word)
11-023	FRC Quarterly Report Form	02-2024	English (Word)
11-022	Family Resource Center Capacity Building Work Plan		English (Word)
11-021	HV-BAT Supplemental Form		English (Word)
11-020	Tribal Fatherhood Support Program Funding Opportunity		English (Word)
11-019	Diaper Bank Concrete Good for Families Quarterly Report Form		English (Word)
11-018	Perinatal Mental Health Returning Program	04-2024	English (Word)
11-017	Diaper Bank Partnership Quarterly Report Form		English (Word)
11-016	Perinatal Mental Health Year-End Community Report Template		English (Word)
11-015	CBCAP Returning Programs	04-2024	English (Word)
11-014	Family Resource Center Capacity Building Funding Opportunity		English (Word)
11-011A	HVSA Tribal Home Visiting Funding Opportunity Letter of Intent		English (Word)
11-011	2022 Spring HVSA Expansion Funding Opportunity Letter of Intent to Apply		English (Word)
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)
10-606	Adoptive Parent Counseling Preauthorization for Services		English (Word) English (PDF)
10-586	Preauthorization for In-Home Services		English (Word) Spanish (Word) Spanish (PDF)
10-567	Contracted Health and Safety Visit Report		English (Word) English (PDF)
10-566	Contracted Health and Safety Visit Referral		English (Word) English (PDF)
10-546	Adoption Archive Request for Non-Identifying Information		English (Word) English (PDF)
10-545	Family Feedback Questionnaire		English (Word) English (PDF)
10-540	Project SafeCare Monthly Summary		English (Word) English (PDF)
10-539	Interstate Compact for the Placement of Children (ICPC) Reference Questionnaire for Parent Home Study		English (Word) English (PDF) Spanish (Word) Spanish (PDF)
10-537	Interstate Compact for the Placement of Children (ICPC) Parent Home Study Information		10-537 10-537 Spanish (PDF) Spanish (Word)
10-500	Acknowledgement of Child’s Adoptive File Provided to Adoptive Family:		English (Word) Spanish (Word) Somali (PDF) Spanish (PDF) Vietnamese (PDF)
10-490	Child Specific Contract or Extra Supervision Rate Proposal		English Excel
10-484	Youth Run Prevention Plan		English (Word) English (PDF)
10-480	Comprehensive Family Evaluation		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)
10-477	Adoption Support Program Application Checklist		English (Word) English (PDF)
10-475	Early Invention Program (EIP) Exit Summary		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)
10-464	FamLink Access Application and Acknowledgement		English (Word) English (PDF)
10-463	FamLink Data Access Request / Change		English (Word) English (PDF)
10-462	User Application and Acknowledgement		English (Word) English (PDF)
10-459	Courtesy Supervision Referral		English (Word) English (PDF)
10-455	Medication Log	02-2024	English (Word) English (PDF) Spanish (Word) Spanish (PDF)
10-454	DCYF Caregiver Authorization		English (PDF) Laotian (PDF) Mam (fillable PDF) Spanish (fillable PDF)
10-453	Home Inspection Checklist (Kinship)		English (Word) Spanish (Word) Spanish (PDF)
10-432	Extended Foster Care Program Participation Agreement		English (Word) English (PDF) French (PDF) Mam (PDF) Spanish (Word) Spanish (PDF)
10-428	Caregiver Support Plan		English (Word) English (PDF)
10-425	Reference Questionnaire (Certified Respite)		English (Word) Spanish (Word) Spanish (PDF)
10-419	Supervision Plan for Site Specific Conditions	11-2022	English (Word) Spanish (PDF) Soninke (PDF)
10-416	Foster Home Monitoring Visit		English (Word) Spanish (PDF) Spanish (Word)
10-408	Application for Child Care Agency License or Certification		English (Word) English (PDF)
10-405B	Foster Home Move Reassessment		English (Word)
10-405	Foster Home Reassessment		English (Word)
10-395	Intensive Family Service Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary		English (Word) English (PDF)
10-354	Home Study or Reassessment Application	11-2022	English (Word) Amharic (PDF) Marshallese (PDF) Maay Maay (PDF) Oromo (PDF) Samoan (PDF) Somali (PDF) Soninke (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF) Trukese (PDF) Vietnamese (PDF)
10-290	WAC Agreements	03-2023	English (Word) Amharic (PDF) Oromo (PDF) Somali (PDF) Soninke (PDF) Spanish (Word) Spanish (PDF) Tigrigna (PDF) Trukese (PDF) Vietnamese (PDF)
10-248C	Compliance Agreement for Group Care	11-2023	English (Word)
10-248B	Compliance Agreement for Child Placing Agency (CPA)	11-2023	English (Word)
10-248	Compliance Agreement	11-2022	English (Word) Spanish (PDF) Spanish (Word)
10-214	Pre-Authorization For Services		English (Word) English (PDF)
10-183	Home Inspection Checklist (Licensed)		English (Word) Marshallese (PDF) Spanish (Word) Spanish (PDF)
10-182C	File Checklist (Kinship License)		English (Word)
10-182B	File Checklist (Provisional Expedited License)		English (Word)
10-182A	File Checklist (Unlicensed)		English (Word) Spanish (Word) Spanish (PDF)
10-182	File Checklist (Foster License)		English (Word)
10-166A	Behavioral Rehabilitation (BRS) Referral		English (Word) English (PDF)
10-114	Adoption Data Card		English (Word) English (PDF)
10-083	Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment		English (Word) English (PDF)
10-082	Adoption Support Modification Worksheet	01-2024	English (Word) English (PDF) Spanish (PDF) Spanish (Word)
10-061	Child’s Registration		English (Word) English (PDF)
10-056	Initial/Kinship License Request for Tribes	03-2024	English (Word)
10-055	Group Receiving Center Checklist
10-046B	Budget for Group Care
10-046	Budget for Child Placing Agency (CPA)
10-045B	Policies and Procedures for Group Care
10-045A	Policies and Procedures for Child Placing Agency (CPA) Adoption Only
10-045	Policies and Procedures for Child Placing Agency (CPA) Foster Care
10-043	Home Study	12-2023	English (Word) Amharic (PDF) Samoan (PDF) Somali (PDF) Spanish (PDF) Spanish (Word) Tigrigna (PDF) Vietnamese (PDF)
10-042	Child Protective Services Casework Checklist		English (Word) English (PDF)
10-036	Emergency Placement Services (EPS) Transition Summary	01-2024	English (Word)
10-035	Receiving Care Transition Summary	12-2023	English (Word)
10-016	File Checklist and Certification for License of Foster Home	03-2024	English (Word)
09-998	Application for the Adoption Support Program and/or Reimbursement of Adoption Finalization Costs		English (Word) English (PDF) Ukrainian (PDF) Vietnamese (PDF)
09-997	Adoption Support Worksheet		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF) Ukrainian (PDF) Vietnamese (PDF)
09-966	Authorization to Release Information to the Court		English (Word) English (PDF)
09-837	Disclosure of Confidential HIV / AIDS Information		English (Word) English (PDF)
09-765	Declaration of Adoption Facilitator - Indian Child	04-2023	English (Word) English (PDF) Spanish (Word) Spanish (PDF)
09-761	Indian Identity Request		English (Word) English (PDF)
09-653	Background Check Authorization		English (Word) English (PDF) Amharic (PDF) Cambodian (PDF) Chinese (PDF) Chinese (PDF) Korean (PDF) Laotian (PDF) Maay Maay (PDF) Punjabi (PDF) Russian (PDF) Somali (PDF) Spanish (PDF) Vietnamese (PDF)
09-611	Release and Consent for Child Specific Recruitment		English (Word) English (PDF) Spanish (PDF) Spanish (Word)
09-539	Inquiry to Indian Tribe		English (Word) English (PDF)
09-165	Portable Background Check Application	03-2024	English (PDF)
09-164	Request for Early Learning Background Check Results	03-2024	English (Word) English (PDF) Somali (PDF) Spanish (PDF) Spanish (Word)
09-162	Background Check Reconsideration Request		English (Word) English (PDF)
09-160	Background Check Hearing Request Form		English (Word) English (PDF)
09-154	NCIC Purpose Code C Background Check Summary		English (Word) English (PDF)
09-134	Relative Inquiry		English (PDF) Download and save to desktop before filling in form. Marshallese (PDF) Trukese (PDF)
09-133	Group Care Background Check Request/Decision Form	10-2023	English (Word) English (PDF)
09-132	Employee Background Check Request/Decision		English (Word) English (PDF)
09-131	Background Check Request/Decision		English (Word) English (PDF) Marshallese (PDF) Spanish (Word) Spanish (PDF) Vietnamese (PDF)
09-129	Child Near Fatality Case Review Confidentiality Agreement		English (Word) English (PDF)
09-128	Child Fatality Case Review Confidentiality Agreement		English (Word) English (PDF)
09-127	Rights of Children and Youth in Foster Care		English (Word) English (PDF)
09-126	Local Indian Child Welfare Advisory Committee Confidentiality Agreement		English (Word) English (PDF)
09-121	Waiver of Right to Receive Written Information on Adoption Support Program Limitation		English (Word) English (PDF)
09-111	Continuous Quality Improvement Confidentiality Agreement		English (Word) English (PDF)
09-104	ICPC Closure Letter		English (Word) English (PDF)
09-102	Hiring Education Affidavit Request (Outdoor Nature-Based)		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)
09-100	Hiring Education Affidavit Request (Early Learning)		English (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF)
09-093	School Notification	10-2023	English (Word) Spanish (Word) Spanish (PDF)
09-082	Five Day Notification to Move		English (Word) English (PDF)
09-056	Dependent/Ward of the Court Verification		English (Word) English (PDF)
09-054	Waiver of Notice of Further Hearing		English (Word) English (PDF)
09-031	Authorization By Subject of Records Requested		English (Word) English (PDF)
09-026	DSO & Jail Removal Data Form		English (Word)
09-013	Vendor Affidavit of Lost, Stolen or Destroyed Warrant	02-2022	English (Word) English (PDF) Portuguese (PDF) Spanish (Word) Spanish (PDF)
09-012	Request for Certificate of Parental Improvement (CPI)		English (Word) English (PDF)
09-010	Child Welfare History		English (Word)
09-008	Victim/Witness Notification Program Enrollment (save to your computer before filling out)		English (PDF)
09-007	Petition for Review of Initial Decision (Appeal)		English (Word) English (PDF)
08-050	Request/Certification of Data Destruction		English (Word) English (PDF)
07-112a	Early Achievers Needs-Based Grant Receipt Verification Form		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)
07-110C	Stabilization Grant Receipt Verification Form Workforce Amounts		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
07-110B	Stabilization Grant Receipt Verification Form Program and Add-On Amounts		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
07-110A	Child Care Stabilization Grant Spend Period Extension Request		English (Word) Somali (PDF) Spanish (PDF) Spanish (Word)
07-110	Child Care Stabilization Grant Application – Family, Friend, and Neighbor (FFN) License- Exempt Providers		English (PDF) Somali (fillable PDF) Spanish (fillable PDF)
07-090 Contact Forms Manager for translation revisions	Caregiver Monthly Transportation Reimbursement		English (Word) English (PDF) Spanish (Word) Spanish (PDF) Vietnamese (PDF)
07-085	Client Travel Approval Quick Reference Guide	03-2024	English (PDF)
07-035	Child Care Complex Needs Fund Verification		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
07-020	ECEAP Service Purchase Request		English (Word) English (PDF)
06-179	Education and Training Voucher (ETV) Spending Plan		English (Excel)
06-172	Domestic Violence Prevention Account		English (Word) English (PDF)
06-166	Individual Training Plan		English (Word) Spanish (Word) Spanish (PDF)
06-165	Extended Foster Care (EFC) Denial Letter		English (Word) English (PDF) Spanish (Word) Spanish (PDF)
06-160	Adoption Support Monthly Counseling Billing		English (Word) English (PDF)
06-097	Provider File Action Request		English (Word) English (PDF)
06-025	Professional Services Billing Statement		English (Word) English (PDF)
06-010	Electronic Attendance System Vendor Approved Checklist		English (Word) English (PDF)
05-325	ECEAP Porgram Monitoring Document Review Checklist		English (Word) English (PDF)
05-320	2018-19 Financial Disclosure Certification		English (PDF)
05-305	ADA/504 Discrimination Complaint/Grievance Form		English (PDF)
05-250	Certification Regarding Environmental Tobacco Smoke		English (Word) English (PDF)
05-101	Staff Selection Criteria for Evidence Based Practices (EBP's)	03-2024	English (Word)
05-061	Combined In-Home Service (CIHS) Inquiry	03-2024	English (Word)
05-060	Evidence Based Readiness Assessment	08-2023	English (Word)
05-051	Citizen Review Panel Confidentiality Agreement		English (Word)
05-050	Citizen Review Panel Membership Application		English (Word)
05-041A	Licensing Division Practice Change Request		English (Word)
05-041	Licensing Dvisions Practice Change Request Review & Approval		English (Word)
05-037	ECLIPSE Prioritization Worksheet	04-2024	English (Word)
05-036	Verification of ECEAP Eligibility	04-2024	English (Word)
05-035	ECEAP & Early ECEAP Parent & Family Voices (PFV) PFV Representative ("Rep") Recruitment		English (Word) Somali (PDF) Spanish (PDF) Spanish (Word)
05-034	ECLIPSE RFA Applications and Guides		Request for Application References Budget Form ECLIPSE Request for Application Guide ECLIPSE Minimum Service Delivery Requirements Table
05-033	Approval of New B-5 Subcontractos (ECEAP) 2023-2024		English (Word)
05-032	ECEAP Complex Needs Fund Application FY 2024-25		English (Word)
05-031	Parent Consent to Transfer ELMS Records		English (Word) English (PDF) Spanish (PDF)
05-027	ECLIPSE Services Application Packet		Exhibit D: Startup Budget Exhibit E: ECLIPSE Services Application Form Exhibit F: Certifications and Assurances
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
05-024	ECEAP Contractor Equipment Disposal Request		English (Word) English (PDF)
05-022	ECEAP Contract Waiver-Variance Request to ECEAP Requirements		English (Word)
05-021	ECEAP Contractor Alternative Attendance Plan Request		English (Word) English (PDF)
05-012	Approval of New Early ECEAP Site/Classroom		English (Word)
05-010	ECEAP Professional Development Plan Lead Teacher		English (Word) English (PDF)
05-009	ECEAP Professional Development Plan Assistant Teacher		English (Word) English (PDF)
05-008	Early ECEAP Pre-screen and Application	03-2024	English_2024-2025 Spanish_2024-2025 English_2024-2025_Pre-Screen English_2024-2025_Application
05-007A	ECEAP Services Carryforward Plan		English (Excel)
05-007	ECEAP Contractor Financial Disclosure Certification		English (PDF)
05-006	ECEAP Pre-screen & Application (Combined Form)	03-2024	English_2024-2025 Amharic_2024-2025 Arabic_2024-2025 Korean_2024-2025 Russian_2024-2025 Ukrainian_2024-2025 Vietnamese_2024-2025 Spanish_2024-2025 English_2024-2025_Pre-screen Spanish_2024-2025_Prescreen English_2024-2025_Application Spanish_2024-2025_Application
05-005	Education Appeal		English (Word) English (PDF)
05-004	ECEAP Community Funded		English (Word) English (PDF) Somali (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
05-003	Provider Application Form		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)
05-001	Expression of Interest		English (Word) English (PDF) Somali (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
04-225	CBCAP Quarterly Report		English (Word)
04-220	Family Ancestry Chart		English (Word) English (PDF)
03-493	Foster Parent Donor Shared Leave		English (Word) English (PDF)
03-492	Foster Parent Recipient Shared Leave		English (Word) English (PDF)
03-415	Facility Short Term Use Application		English (Word) English (PDF)
03-374B	Agreement on Nondisclosure of Confidential Information-Non Employee		English (Word) English (PDF)
02-206	Statement of Earnings		English (Word) English (PDF) Albanian (PDF) Spanish (PDF)
02-031	WA State Citizen Review Panels (CRP) Data Request Form		English (Word)
02-026	Unsung Hero Nomination Form		English (Word) English (PDF) Somali (Word) Spanish (Word)
02-020	Guide to Background Checks		English (PDF)
02-006	Treatment Foster Care Initiative (TFCI) Referral		English (Word) Treatment Foster Care Initiative (TFCI) Information
02-003b	Parent Advisory Group (PAG) Application		English (Word) Somali (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
02-003a	Application for Provider Supports Subcommittee		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
02-003	Application for Early Learning Advisory Council		English (Word)
00-020	4th Annaul DCYF Indigenous Children, Youth, and Families (ICYF) Conference		English (Word)
00-005b	2023 HVSA Application for Funding Home Visiting Exploration Planning		English (Word)
00-005A	2022 Spring HVSA Tribal Expansion Funding Application		English (Word)
00-005	HVSA Expansion Application Template		English (Word)
00-002	COVID- 19 Prevention, Intervention and Quarantine Plan		English (Word)
	State Fiscal Quarterly Report		English (Excel)
	Provider Registration Form		English (PDF)
	Provider Direct Deposit Authorization Form		English (PDF)
	File Checklist (Kinship License)		English (Word)
	Provider Change Form		English (PDF)

27-164

Single Parent Declaration

09-2020

English (Word)
English (PDF)
Albanian (PDF)
Amharic (PDF)
Arabic (PDF)
Chamarro (PDF)
Chinese (PDF)
Farsi (PDF)
Fijan (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)

23-046

ECEAP Program Monitoring Community Partner Questionnaire

English (Word)
English (PDF)

23-041

Washington State Child Abuse and Neglect Founded Findings Request from Another State

English (Word)
English (PDF)

23-037

Background Clearance Notification

English (Word)

23-036

Child Placing Agency Foster Home Licensing Investigation

English (Word)

23-035

CHINS/ARY Report to Juvenile Court

English (Word)
English (PDF)

23-033

Child Abuse and Neglect Information Request

English (Word)
English (PDF)

23-032

In-State Child Abuse and Neglect Founded Findings Request

English (Word)
English (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)

23-006

Three-Pronged Approach (TPA) Developmental Skills Checklist Related to Vision and Hearing in Young Children

English (PDF)
Spanish (fillable PDF)

23-005

Three Pronged Approach (TPA) I. Parent Interview Questions Related to Vision and Hearing

English (Word)
Spanish (fillable PDF)

20-270

Juvenile Justice System Improvement Technical Assistance Grant Application

English (Word)

20-020

Acknowledgement of JR Policy 6.70 Marriage in JR Facilities

English (Word)
English (PDF)

20-017

JR Marriage Application

English (Word)
English (PDF)

20-016

JR Marriage Approval for Release of Information

English (Word)
English (PDF)

20-015

Juvenile Rehabilitation Youth Engagement Request

English (Word)

19-015

Workforce Retention Grant Verification Form

English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)

18-400A

Foster Caregiver Third Party Liability Claim

English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)

18-400

Foster Caregiver Reimbursement Claim

English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)

17-251

FERPA Access Request

English (Word)
English (PDF)

17-215A

DCYF Checklist: Subcontractor Approval Request

English (Word)
English (PDF)

17-215

DCYF Checklist: Subcontractor Approval Request

English (Word)
English (PDF)

17-063

Written Authorization

English (Word)
English (PDF)
Vietnamese (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)

17-041A

Request for DCYF Records

02-2024

English (Word)
English (PDF)

16-235

Photo, Video or Audio Release Waiver

English (PDF)
Chinese (PDF)
Somali (PDF)
Spanish (PDF)

16-225

File Checklist (Certified Respite)

English (Word)
Spanish (Word)
Spanish (PDF)

16-217

Washington State ICPC Quarterly Supervision Report

English (Word)
English (PDF)

16-209

Archived Records Memo Adoption and/or Legally Free Children Aged Out

English (Word)
English (PDF)

16-204

Emergency and Evacuation Plan

01-2023

English (Word)
Marshallese (PDF)
Samoan (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)

16-190

Overnight Youth Shelter Checklist

01-2019

English (Word)

16-189

Group Home Checklist

01-2019

English (Word)

16-188

Medically Fragile and Children with Intellectual and Developmental Disabilities Checklist

01-2019

English (Word)

16-186

Crisis & Secured Crisis Residential Checklist

01-2019

English (Word)

16-184

Maternity Services Checklist

01-2019

English (Word)

16-183

Emergency Respite Center Checklist

01-2019

English (Word)

16-179

Reference Questionnaire Request

English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)

16-030

Book Review Worksheet for Foster Parent Training Hours

English (Word)
Spanish (Word)
Spanish (PDF)

16-025

Contractor Certification

English (Word)

16-015

State Approved Training Concern Form

English (Word)
English (PDF)

16-010

Parental Advisory Group (PAG) Cover Letter and Application

English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
Spanish (Word)

16-005

Electronice Attendance Provider Welcome Letter (Barcode)

English (Word)
English (PDF)

15-980

School Age License Application

01-2024

English (Word)
English (PDF)

15-974

Declaration of Compliance

12-2023

English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)

15-970

Individual Care Plan for Child in Child Care

English (Word)
English (PDF)
Spanish (PDF)

15-969

Child Care Medication Log

Englislh (Word)
Somali (PDF)
Spanish (PDF)

15-968

Child Care Medication Authorization

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-967

Child Care Health Consultant Onsite Report

English (Word)
Engllish (PDF)
Somali (PDF)
Spanish (PDF)

15-966

Child Care Health Consultant Agreement

Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-965

Sanitizer Disinfectant Approval Request

English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)

15-964

Early Learning-Child Care Facility Feasibility Checklist (sa)

English (Word)

15-963

Early Learning-Child Care Facility Feasibility Checklist

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

15-961

Child Care Waiver Request

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-957

Child Care Variance Request

English (Word)
Somali (PDF)
Spanish (PDF)

15-956

No Social Security Card Declaration

English (Word)
Somali (PDF)
Spanish (PDF)

15-955

Family Home and Center Child Care License or Certification Application

01-2024

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)

15-954

Notification of Staffing Plan Absence

English (Word)
Somali (PDF)
Spanish (PDF)

15-952

Notification to Parents and Guardian - Safe Sleep Non-Compliance

English (PDF)
Somali (PDF)
Spanish (PDF)

15-949

Family Home Child Care Background Checklist

09-2023

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-945

Tribal Certification Request

English (Word)

15-944

School Based and Military Certification for Payment Only Request

English (Word)

15-943

Child Care Agreement

English (Word)
Spanish (Word)

15-942

Daily Child Attendance Records

English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

15-941

Child Care Injury Incident Report

Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Spanish (Word)

15-937

Child Care Center School-Age Background Checklist

01-2024

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)

15-899

Child Licensee or Assistant Resume

English (Word)
English PDF)
Somali (PDF)

15-897

Child Care Parent Guardian Permissions

English (Word)
English (PDF)
Somali (Word)
Spanish (Word)

15-896

Probation Notification Letter to Parents from Provider

English (Word)

15-895

Overnight Child Care Planning Guide

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-894

Family Home Child Care Liability Insurance Form

Engllish (Word)
English (PDF)
Somali (PDF)
Spanish PDF)

15-893

Multiple Licenses Request Form

English (Word)

15-892

Fire, Safety, Emergency Drills Record

English (Word)
Somali (PDF)
Spanish (PDF)

15-891

Chimney, Fireplace, Woodstove Use Statement

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-889

Sample Application for Employment or Volunteer Services Licensed or Certified Early Learning/Child Care Program

English (Word)
English (PDF)

15-879

Child Care Registration (fh/ctr)

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-874

Capacity Increase Change Planning Guide

English (Word)
English (PDF)

15-863

Initial Checklist for School-Age Program Applicant

05-2023

English (Word)

15-862

Initial Checklist for Family Home Child Care Applicant

05-2023

English (Word)

15-861

Initial Checklist for Child Care Center Applicant

05-2023

English (Word)

15-860

Medication Permission Form For Illness and Allergies (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)

15-858

Emergency Contact and Permission Form (FFN)

English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)

15-857

Parent/Provider Health Safety Agreement (FFN)

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)

15-852

Plan to Meet Experience Qualification

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)

15-845

ONB Monitoring Checklist (Example)

English (Word)

15-841

ONB Initial Checklist for Applicant

English (Word)

15-835

Outdoor Nature-Based Child Care License or Certification Application

01-2024

English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)

15-827

Kinship Caregiver iPad Equipment Checkout Agreement

English (Word)
Spanish (Word)
Spanish (PDF)

15-826

Pet Vaccination Agreement

06-2023

English (Word)
English (PDF)
Maay Maay (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)

15-824b

Authorization and Consent to Share Records (Child Placing Agency/Group Care Staff)

English (Word)
English (PDF)

15-824A

Authorization and Consent to Share Records (CPA Home)

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

15-824

Authorization and Consent to Share Records

English (Word)
Spanish (Word)
Spanish (PDF)
Trukese (PDF)
Vietnamese (PDF)

15-823

Pertussis Vaccination Agreement

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)

15-822a

Vaccine Agreements Certified Respite

English (Word)
English (Word)
Spanish (Word)
Spanish (fillable PDF)

15-822

Influenza Vaccination Agreement

09-2022

English (Word)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Tigrigna (PDF)
Vietnamese (PDF)

15-821a

Infant Safety Certified Respite

English (Word)
Spanish (Word)
Spanish (PDF)

15-821

Infant Safety Agreement

English (Word)
Marshellese (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)

15-820

Tuberculosis (TB) Screening LD

06-2023

English (Word)
English (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)

15-720

Interest Survey for Organization License Pilot

English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)

15-716

Benefit-Risk Assessment and Mitigation Development for Outdoor Nature-Based (ONB) Child Care Programs

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

15-709

Family Home Child Care Monitoring Checklist (Example)

English (Word)

15-708

Child Care Center Monitoring Checklist (Example)

English (Word)

15-707

School-Age Child Care Monitoring Checklist

English (Word)
English (PDF)

15-705

FFN Waiver Request

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

15-703

Declaration of Compliance (for Outdoor Nature-Based Programs)

English (Word)
Spanish (Word)
Spanish (PDF)

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)

15-489

Placement Entry Tool

English (Word)
English (PDF)

15-472

After-the-Fact Contract Justification

English (Word)

15-470

DCYF Regional Contract Request

English (Word)
English (PDF)

15-469

Pre-Contract Action Request (P-CAR)

English (Word)
English (PDF)

15-466

Contract Risk Assessment / Analysis

English (PDF)

15-460

Background Confirmation and Out of State Check

03-2024

English (Word)

15-455

Vaccine Exemption

English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)

15-454

Unusual Incident Report

English (Word)

15-452

Sibling Visit Report

English (Word)
English (PDF)

15-451

Missed and No Show Report: Parent – Child Visit

English (Word)
English (PDF)

15-450

Child Specific Caregiver Notification

English (Word)
English (PDF)

15-448A

Supported Visit Report

English (Word)
English (PDF)

15-448

Family Time Report

English (Word)
Spanish (Word)
Spanish (PDF)

15-434

On-Going Mental Health (OMH) Screening Report

English (Word)
Spanish (Word)
Spanish (PDF)

15-431

Extended Foster Care Program Voluntary Placement Agreement (VPA)

English (Word)
English (PDF)
Dari (PDF)
French (PDF)
Spanish (PDF)
Spanish (Word)

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)

15-425

Adoption Redaction Request

English (Word)
English (PDF)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)

15-417

Transition Plan for Youth Exiting Care

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

15-416

Interstate Compact for Adoption Medical Assstance ICAMA

English (Word)

15-412

Request for Extension and Disability Verification for Youth Over Age 18

English (Word)
English (PDF)

15-411G

Kinship License Non-Safety Exemption/Waiver (Licensed Home)

15-411G.docx

15-411D

Administrative Approval (Foster Home)

English (Word)

15-411A

Licensing Waiver (Foster Home)

English (Word)

15-402

Notice to Foreign Consulate of Child Protection Proceedings

English (Word)
English (PDF)

15-386

Independent Living Learning Plan and Progress Report - IL Provider

02-2024

English (Word)

15-377

Education and Training Voucher (ETV) Program Dual Credit Application

English (Word)

15-372

Enumeration Referral

English (Word)
English (PDF)

15-370

Education and Training Voucher (ETV) Program Payment Request

English (Word)
English (PDF)

15-369

Education and Training Voucher (ETV) Program 2024 - 2025 Renewal Application

08-2023

English (Word)

15-368A

Education and Training Voucher (ETV) Program Dual Credit Participation Agreement

English (PDF)
English (Word)

15-368

Education and Training Voucher (ETV) Program Participation Agreement

English (Word)
English (PDF)

15-363C

Visit Coordination Plan

English (Word)
English (PDF)

15-363B

Provider Notification of Visit/Transport Schedule Initial Intake Screening Report

English (Word)
English (PDF)

15-362

Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home

English (Word)
English (PDF)

15-359

Child's Physical Description

English (Word)
English (PDF)

15-349a

Kinship Respite Overcapacity WAC 110-148-1390

English (Word)

15-324

Guardianship Approval Checklist

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)

15-313A

Caregiver's Report to the Court (Abbreviated)

English (Word)
Spanish (Word)
Spanish (PDF)

15-313

Caregiver's Report to the Court

06-2023

English (Word)
Spanish (Word)
Spanish (PDF)

15-309

Returning Child De-Briefing

English (Word)
English (PDF)

15-308

Missing Child Staffing

English (Word)
English (PDF)

15-300

Child Information and Placement Referral

English (Word)
English (PDF)

15-286A

Adult Child Reference Questionnaire

English (Word)
English (PDF)
Arabic (PDF)
Marshallese (PDF)
Spanish (PDF)
Tagalog (PDF)

15-286

Reference Questionnaire

01-2023

English (Word)
English (PDF)
Arabic (PDF)
Marhsallese (PDF)
Russian (PDF)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Tagalog (PDF)
Vietnamese (PDF)

15-281

Placement Agreement

07-2023

English (Word)
Arabic (PDF)
Chinese (PDF)
Russian (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)

15-280

Unlicensed Caregiver Placement Checklist

06-2023

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

15-276

Personal Information

English (WORD)
Marshallese (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tagalog (PDF)
Tigrigna (PDF)
Trukese (PDF)

15-268

Child Protect Teams (CPT) Case Presentation Summary

English (Word)
English (PDF)

15-267

Attendance and Confidentiality Agreement

English (Word)
English (PDF)
Vietnamese (PDF)

15-266

Child Protect Teams (CPT) Staffing Recommendations

English (Word)
English (PDF)

15-260

Parents Information Sheet for Shared Planning Meetings and Staffings

English (Word)
English (PDF)

15-259A

Case Plan

English (Word)
English (PDF)
Chinese (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)

15-258B

Safety Plan

05-2023

English (Word)
Spanish (Word)
Spanish (PDF)

15-258A

Safety Assessment

English (Word)

15-258

Safety Assessment / Safety Plan Combined

05-2023

English (Word)
Haitian-Creole (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Trukese (PDF)
Trukese (PDF)

15-245

LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record

English (Word)
English (PDF)
Spanish (Word)
Spanish (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)

15-209A

Health/Mental Health and Education Summary

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)

15-092

The Interstate Compact on the Placement of Children (ICPC) Placement Request

English (Word)
English (PDF)

15-060

Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report

English (Word)

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)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese

15-058

Parent Prior Written Notice

01-2019

English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (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)

15-056

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)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telegu (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)

15-054

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)

15-053

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)

15-052

Declining Participation in the ESIT Program

English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Portuguese (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

15-050

Confirmation of Individualized Family Service Plan (IFSP) Schedule

English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)

15-030

Substance Use Disorder Professional (SUDP) Referral

04-2024

English (Word)

15-029

Psychiatric Services Referral

English (Word)
English (PDF)

15-028

Psychological Services Referral

English (Word)
English (PDF)

15-027

Professional Services Referral

English (Word)
English (PDF)

15-016

HVSA Local Implementing Agency Contact Update Form

English (Word)
English (PDF)

15-015

Child Care Subsidy Program Site Change Form

English (Word)
English (PDF)

15-005

ESIT Health Care Referral Form

English (Word)
English (PDF)

14-600

Interim Individualized Family Service Plans (IFSP) (ESIT)

English (Word)

14-548

Independent (IL) / Transitional Living (TL) Grant Application

English (Word)
English (PDF)

14-545

Extended Adoption Support Application

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

14-531A

Education and Training Voucher (ETV) Program and Passport to Careers Program Application Consent

English (Word)
English (PDF)

14-531

Education and Training Voucher (ETV) Program and Passport to Careers Program 2024 – 2025 Application

08-2023

English (Word)

14-512

Application for Certified Respite Provider

English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)

14-510

Certified Respite Provider Agreements

English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)

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)

14-452

Financial Worksheet

09-2022

English (Word)
English (PDF)
Marshallese (PDF)
Oromo (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
Tagalog (PDF)
Vietnamese (PDF)

14-446

Declaration of Financial Status for Adoption Support Application

English (Word)
English (PDF)

14-444

Child Health and Education Tracking Screening Report

09-2023

English (Word)
Spanish (Word)
Spanish (PDF)

14-438

Stop Work

English (Word)
Amharic (PDF)
Arabic (PDF)
Chinese (PDF)
Dari (PDF)
Oromo (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)

14-435

Provider Employment Eligibility Verification

English (Word)
English (PDF)

14-434

Title IV-E Requirements for Out of State Foster Care Payments

English (Word)
English (PDF)

14-430

CCSP Child Care Reapplication

08-2022

English (Word)
Albanian (PDF)
Arabic (PDF)
Cambodian (PDF)
Chamarro (PDF)
Chinese (PDF)
Dari (PDF)
Farsi (PDF)
French (PDF)
French (PDF)
Haitian-Creole (PDF)
Hindi (PDF)
Italian (PDF)
Korean (PDF)
Lingala (PDF)
Oromo (PDF)
Pashtu (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Swahili (PDF)
Thai (PDF)
Tigringa (PDF)
Ukrainian (PDF)
Vietnamese (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)

14-319A

IV-E Eligibility Determination for Federal Funds for GAP, Guardianship Assistance Program

English (Word)
English (PDF)

14-319

IV-E Eligibility Determination for an Adoption Support Application

English (Word)
English (PDF)

14-293

Title IV-E Initial Eligibility Determination Income Calculation Worksheet

English (Word)
English (PDF)

14-281

Source of Funds Application for Child in Placement

English (Word)
English (PDF)

14-255

Early Childhood Equity Grant Application

02-2024

English (Word)

14-252

Employment Verification

08-2022

English (Word)
English (PDF)
Albanian (PDF)
Amharic (PDF)
Cambodian (PDF)
Chinese (PDF)
Dar (PDF)
Farsi (PDF)
French (PDF)
Haitian-Creole (PDF)
Korean (PDF)
Lingala (PDF)
Mongolian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Swahili (PDF)
Tagalog (PDF)
Turkish (PDF)
Ukaranian (PDF)
Vietnamese (PDF)

14-224

Statement from Landlord/Manager

01-2023

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)
Oromo (PDF)
Portuguese (PDF)
Punjabi (PDF)
Romanian (PDF)
Russian (PDF)
Rwanda (PDF)
Swahili (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (PDF)
Tagalog (PDF)
Tigrigna (PDF)
Turkish (PDF)
Trukese (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)

14-040

Non ECEAP Child Request for ECLIPSE Enrollment

02/2024

English (Word)

14-025

Early Achievers Extension Application

English (Word)
Somali (Word)
Spanish (Word)

14-012

Consent for Release of Information

05-2023

English (Word)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
French (PDF)
Laotian (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (PDF)
Ukranian (PDF)
Vietnamese (PDF)

14-011a

Change Form Medical and Dental Benefits

English (PDF)
Spanish (fillable PDF)
Somali (fillable PDF)

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)

14-005

OJJDP Title II Pass Through Fund

English (Word)

14-003

Trainer Observation Rubric (Self Paced)

English (Word)

14-002

Trainer Observation Rubric

English (Word)
English (PDF)

14-001

Employment Verification for State Training

07-2021

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

13-908

Brief Assessment of Anxiety and PTSD: Child / Youth (SCARED)

01-2024

13-907

Brief Assessment of Anxiety and PTSD: Caregiver/Parent

English (Word)
English (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)

13-904

Diabetes Care and Action Plan

English (Word)
English (PDF)

13-200

Health & Safety Checklist

English (Word)

13-041

Family Genetic and Medical History

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)

13-001B

Applicant Mental Health Report

English (Word)
Spanish (PDF)

13-001A

Applicant Medical Self Report

English (Word)
Marshallese (PDF)
Oromo (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)

13-001

Applicant Medical Report- Confidential

09-2022

English (Word)
Oromo (PDF)
Samoan (PDF)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
Soninke (PDF)
Tagalog (PDF)
Tigrigna (PDF)
Vietnamese (PDF)

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)
Lingala (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tigrigna (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)

11-032

Strengthen Families Locally (SFL) Budget Templatae

English (Excel)

11-031

Strengthen Families Locally Priority Project Proposal

English (Word)

11-030

Youth and Young Adult Housing Response Team Referral

English (Word)

11-029

Quarterly Reporting Tool - Stengthen Families Locally

English (Excel)

11-028

Tribal Fatherhood Quarterly Reports

02-2024

English (Word)

11-027

Option 2

English (Excel)

11-026

Option 1B

English (Excel)

11-025

Option 1A

English (Excel)

11-024

Tribal Fatherhood Supports Project Plan

English (Word)

11-023

FRC Quarterly Report Form

02-2024

English (Word)

11-022

Family Resource Center Capacity Building Work Plan

English (Word)

11-021

HV-BAT Supplemental Form

English (Word)

11-020

Tribal Fatherhood Support Program Funding Opportunity

English (Word)

11-019

Diaper Bank Concrete Good for Families Quarterly Report Form

English (Word)

11-018

Perinatal Mental Health Returning Program

04-2024

English (Word)

11-017

Diaper Bank Partnership Quarterly Report Form

English (Word)

11-016

Perinatal Mental Health Year-End Community Report Template

English (Word)

11-015

CBCAP Returning Programs

04-2024

English (Word)

11-014

Family Resource Center Capacity Building Funding Opportunity

English (Word)

11-011A

HVSA Tribal Home Visiting Funding Opportunity Letter of Intent

English (Word)

11-011

2022 Spring HVSA Expansion Funding Opportunity Letter of Intent to Apply

English (Word)

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)

10-606

Adoptive Parent Counseling Preauthorization for Services

English (Word)
English (PDF)

10-586

Preauthorization for In-Home Services

English (Word)
Spanish (Word)
Spanish (PDF)

10-567

Contracted Health and Safety Visit Report

English (Word)
English (PDF)

10-566

Contracted Health and Safety Visit Referral

English (Word)
English (PDF)

10-546

Adoption Archive Request for Non-Identifying Information

English (Word)
English (PDF)

10-545

Family Feedback Questionnaire

English (Word)
English (PDF)

10-540

Project SafeCare Monthly Summary

English (Word)
English (PDF)

10-539

Interstate Compact for the Placement of Children (ICPC) Reference Questionnaire for Parent Home Study

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

10-537

Interstate Compact for the Placement of Children (ICPC) Parent Home Study Information

10-537
10-537
Spanish (PDF)
Spanish (Word)

10-500

Acknowledgement of Child’s Adoptive File Provided to Adoptive Family:

English (Word)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)

10-490

Child Specific Contract or Extra Supervision Rate Proposal

English Excel

10-484

Youth Run Prevention Plan

English (Word)
English (PDF)

10-480

Comprehensive Family Evaluation

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)

10-477

Adoption Support Program Application Checklist

English (Word)
English (PDF)

10-475

Early Invention Program (EIP) Exit Summary

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)

10-464

FamLink Access Application and Acknowledgement

English (Word)
English (PDF)

10-463

FamLink Data Access Request / Change

English (Word)
English (PDF)

10-462

User Application and Acknowledgement

English (Word)
English (PDF)

10-459

Courtesy Supervision Referral

English (Word)
English (PDF)

10-455

Medication Log

02-2024

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

10-454

DCYF Caregiver Authorization

English (PDF)
Laotian (PDF)
Mam (fillable PDF)
Spanish (fillable PDF)

10-453

Home Inspection Checklist (Kinship)

English (Word)
Spanish (Word)
Spanish (PDF)

10-432

Extended Foster Care Program Participation Agreement

English (Word)
English (PDF)
French (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)

10-428

Caregiver Support Plan

English (Word)
English (PDF)

10-425

Reference Questionnaire (Certified Respite)

English (Word)
Spanish (Word)
Spanish (PDF)

10-419

Supervision Plan for Site Specific Conditions

11-2022

English (Word)
Spanish (PDF)
Soninke (PDF)

10-416

Foster Home Monitoring Visit

English (Word)
Spanish (PDF)
Spanish (Word)

10-408

Application for Child Care Agency License or Certification

English (Word)
English (PDF)

10-405B

Foster Home Move Reassessment

English (Word)

10-405

Foster Home Reassessment

English (Word)

10-395

Intensive Family Service Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary

English (Word)
English (PDF)

10-354

Home Study or Reassessment Application

11-2022

English (Word)
Amharic (PDF)
Marshallese (PDF)
Maay Maay (PDF)
Oromo (PDF)
Samoan (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)

10-290

WAC Agreements

03-2023

English (Word)
Amharic (PDF)
Oromo (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)

10-248C

Compliance Agreement for Group Care

11-2023

English (Word)

10-248B

Compliance Agreement for Child Placing Agency (CPA)

11-2023

English (Word)

10-248

Compliance Agreement

11-2022

English (Word)
Spanish (PDF)
Spanish (Word)

10-214

Pre-Authorization For Services

English (Word)
English (PDF)

10-183

Home Inspection Checklist (Licensed)

English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)

10-182C

File Checklist (Kinship License)

English (Word)

10-182B

File Checklist (Provisional Expedited License)

English (Word)

10-182A

File Checklist (Unlicensed)

English (Word)
Spanish (Word)
Spanish (PDF)

10-182

File Checklist (Foster License)

English (Word)

10-166A

Behavioral Rehabilitation (BRS) Referral

English (Word)
English (PDF)

10-114

Adoption Data Card

English (Word)
English (PDF)

10-083

Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment

English (Word)
English (PDF)

10-082

Adoption Support Modification Worksheet

01-2024

English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)

10-061

Child’s Registration

English (Word)
English (PDF)

10-056

Initial/Kinship License Request for Tribes

03-2024

English (Word)

10-055

Group Receiving Center Checklist

10-046B

Budget for Group Care

10-046

Budget for Child Placing Agency (CPA)

10-045B

Policies and Procedures for Group Care

10-045A

Policies and Procedures for Child Placing Agency (CPA) Adoption Only

10-045

Policies and Procedures for Child Placing Agency (CPA) Foster Care

10-043

Home Study

12-2023

English (Word)
Amharic (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tigrigna (PDF)
Vietnamese (PDF)

10-042

Child Protective Services Casework Checklist

English (Word)
English (PDF)

10-036

Emergency Placement Services (EPS) Transition Summary

01-2024

English (Word)

10-035

Receiving Care Transition Summary

12-2023

English (Word)

10-016

File Checklist and Certification for License of Foster Home

03-2024

English (Word)

09-998

Application for the Adoption Support Program and/or Reimbursement of Adoption Finalization Costs

English (Word)
English (PDF)
Ukrainian (PDF)
Vietnamese (PDF)

09-997

Adoption Support Worksheet

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)

09-966

Authorization to Release Information to the Court

English (Word)
English (PDF)

09-837

Disclosure of Confidential HIV / AIDS Information

English (Word)
English (PDF)

09-765

Declaration of Adoption Facilitator - Indian Child

04-2023

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

09-761

Indian Identity Request

English (Word)
English (PDF)

09-653

Background Check Authorization

English (Word)
English (PDF)
Amharic (PDF)
Cambodian (PDF)
Chinese (PDF)
Chinese (PDF)
Korean (PDF)
Laotian (PDF)
Maay Maay (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)

09-611

Release and Consent for Child Specific Recruitment

English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)

09-539

Inquiry to Indian Tribe

English (Word)
English (PDF)

09-165

Portable Background Check Application

03-2024

English (PDF)

09-164

Request for Early Learning Background Check Results

03-2024

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)

09-162

Background Check Reconsideration Request

English (Word)
English (PDF)

09-160

Background Check Hearing Request Form

English (Word)
English (PDF)

09-154

NCIC Purpose Code C Background Check Summary

English (Word)
English (PDF)

09-134

Relative Inquiry

English (PDF) Download and save to desktop before filling in form.
Marshallese (PDF)
Trukese (PDF)

09-133

Group Care Background Check Request/Decision Form

10-2023

English (Word)
English (PDF)

09-132

Employee Background Check Request/Decision

English (Word)
English (PDF)

09-131

Background Check Request/Decision

English (Word)
English (PDF)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)

09-129

Child Near Fatality Case Review Confidentiality Agreement

English (Word)
English (PDF)

09-128

Child Fatality Case Review Confidentiality Agreement

English (Word)
English (PDF)

09-127

Rights of Children and Youth in Foster Care

English (Word)
English (PDF)

09-126

Local Indian Child Welfare Advisory Committee Confidentiality Agreement

English (Word)
English (PDF)

09-121

Waiver of Right to Receive Written Information on Adoption Support Program Limitation

English (Word)
English (PDF)

09-111

Continuous Quality Improvement Confidentiality Agreement

English (Word)
English (PDF)

09-104

ICPC Closure Letter

English (Word)
English (PDF)

09-102

Hiring Education Affidavit Request (Outdoor Nature-Based)

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)

09-100

Hiring Education Affidavit Request (Early Learning)

English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

09-093

School Notification

10-2023

English (Word)
Spanish (Word)
Spanish (PDF)

09-082

Five Day Notification to Move

English (Word)
English (PDF)

09-056

Dependent/Ward of the Court Verification

English (Word)
English (PDF)

09-054

Waiver of Notice of Further Hearing

English (Word)
English (PDF)

09-031

Authorization By Subject of Records Requested

English (Word)
English (PDF)

09-026

DSO & Jail Removal Data Form

English (Word)

09-013

Vendor Affidavit of Lost, Stolen or Destroyed Warrant

02-2022

English (Word)
English (PDF)
Portuguese (PDF)
Spanish (Word)
Spanish (PDF)

09-012

Request for Certificate of Parental Improvement (CPI)

English (Word)
English (PDF)

09-010

Child Welfare History

English (Word)

09-008

Victim/Witness Notification Program Enrollment (save to your computer before filling out)

English (PDF)

09-007

Petition for Review of Initial Decision (Appeal)

English (Word)
English (PDF)

08-050

Request/Certification of Data Destruction

English (Word)
English (PDF)

07-112a

Early Achievers Needs-Based Grant Receipt Verification Form

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)

07-110C

Stabilization Grant Receipt Verification Form Workforce Amounts

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

07-110B

Stabilization Grant Receipt Verification Form Program and Add-On Amounts

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

07-110A

Child Care Stabilization Grant Spend Period Extension Request

English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)

07-110

Child Care Stabilization Grant Application – Family, Friend, and Neighbor (FFN) License- Exempt Providers

English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)

07-090 Contact Forms Manager for translation revisions

Caregiver Monthly Transportation Reimbursement

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)

07-085

Client Travel Approval Quick Reference Guide

03-2024

English (PDF)

07-035

Child Care Complex Needs Fund Verification

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

07-020

ECEAP Service Purchase Request

English (Word)
English (PDF)

06-179

Education and Training Voucher (ETV) Spending Plan

English (Excel)

06-172

Domestic Violence Prevention Account

English (Word)
English (PDF)

06-166

Individual Training Plan

English (Word)
Spanish (Word)
Spanish (PDF)

06-165

Extended Foster Care (EFC) Denial Letter

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)

06-160

Adoption Support Monthly Counseling Billing

English (Word)
English (PDF)

06-097

Provider File Action Request

English (Word)
English (PDF)

06-025

Professional Services Billing Statement

English (Word)
English (PDF)

06-010

Electronic Attendance System Vendor Approved Checklist

English (Word)
English (PDF)

05-325

ECEAP Porgram Monitoring Document Review Checklist

English (Word)
English (PDF)

05-320

2018-19 Financial Disclosure Certification

English (PDF)

05-305

ADA/504 Discrimination Complaint/Grievance Form

English (PDF)

05-250

Certification Regarding Environmental Tobacco Smoke

English (Word)
English (PDF)

05-101

Staff Selection Criteria for Evidence Based Practices (EBP's)

03-2024

English (Word)

05-061

Combined In-Home Service (CIHS) Inquiry

03-2024

English (Word)

05-060

Evidence Based Readiness Assessment

08-2023

English (Word)

05-051

Citizen Review Panel Confidentiality Agreement

English (Word)

05-050

Citizen Review Panel Membership Application

English (Word)

05-041A

Licensing Division Practice Change Request

English (Word)

05-041

Licensing Dvisions Practice Change Request Review & Approval

English (Word)

05-037

ECLIPSE Prioritization Worksheet

04-2024

English (Word)

05-036

Verification of ECEAP Eligibility

04-2024

English (Word)

05-035

ECEAP & Early ECEAP Parent & Family Voices (PFV) PFV Representative ("Rep") Recruitment

English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)

05-034

ECLIPSE RFA Applications and Guides

Request for Application References
Budget Form
ECLIPSE Request for Application Guide
ECLIPSE Minimum Service Delivery Requirements Table

05-033

Approval of New B-5 Subcontractos (ECEAP) 2023-2024

English (Word)

05-032

ECEAP Complex Needs Fund Application FY 2024-25

English (Word)

05-031

Parent Consent to Transfer ELMS Records

English (Word)
English (PDF)
Spanish (PDF)

05-027

ECLIPSE Services Application Packet

Exhibit D: Startup Budget
Exhibit E: ECLIPSE Services Application Form
Exhibit F: Certifications and Assurances

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

05-024

ECEAP Contractor Equipment Disposal Request

English (Word)
English (PDF)

05-022

ECEAP Contract Waiver-Variance Request to ECEAP Requirements

English (Word)

05-021

ECEAP Contractor Alternative Attendance Plan Request

English (Word)
English (PDF)

05-012

Approval of New Early ECEAP Site/Classroom

English (Word)

05-010

ECEAP Professional Development Plan Lead Teacher

English (Word)
English (PDF)

05-009

ECEAP Professional Development Plan Assistant Teacher

English (Word)
English (PDF)

05-008

Early ECEAP Pre-screen and Application

03-2024

English_2024-2025
Spanish_2024-2025
English_2024-2025_Pre-Screen
English_2024-2025_Application

05-007A

ECEAP Services Carryforward Plan

English (Excel)

05-007

ECEAP Contractor Financial Disclosure Certification

English (PDF)

05-006

ECEAP Pre-screen & Application (Combined Form)

03-2024

English_2024-2025
Amharic_2024-2025
Arabic_2024-2025
Korean_2024-2025
Russian_2024-2025
Ukrainian_2024-2025
Vietnamese_2024-2025
Spanish_2024-2025
English_2024-2025_Pre-screen
Spanish_2024-2025_Prescreen
English_2024-2025_Application
Spanish_2024-2025_Application

05-005

Education Appeal

English (Word)
English (PDF)

05-004

ECEAP Community Funded

English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

05-003

Provider Application Form

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)

05-001

Expression of Interest

English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

04-225

CBCAP Quarterly Report

English (Word)

04-220

Family Ancestry Chart

English (Word)
English (PDF)

03-493

Foster Parent Donor Shared Leave

English (Word)
English (PDF)

03-492

Foster Parent Recipient Shared Leave

English (Word)
English (PDF)

03-415

Facility Short Term Use Application

English (Word)
English (PDF)

03-374B

Agreement on Nondisclosure of Confidential Information-Non Employee

English (Word)
English (PDF)

02-206

Statement of Earnings

English (Word)
English (PDF)
Albanian (PDF)
Spanish (PDF)

02-031

WA State Citizen Review Panels (CRP) Data Request Form

English (Word)

02-026

Unsung Hero Nomination Form

English (Word)
English (PDF)
Somali (Word)
Spanish (Word)

02-020

Guide to Background Checks

English (PDF)

02-006

Treatment Foster Care Initiative (TFCI) Referral

English (Word)
Treatment Foster Care Initiative (TFCI) Information

02-003b

Parent Advisory Group (PAG) Application

English (Word)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

02-003a

Application for Provider Supports Subcommittee

English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)

02-003

Application for Early Learning Advisory Council

English (Word)

00-020

4th Annaul DCYF Indigenous Children, Youth, and Families (ICYF) Conference

English (Word)

00-005b

2023 HVSA Application for Funding Home Visiting Exploration Planning

English (Word)

00-005A

2022 Spring HVSA Tribal Expansion Funding Application

English (Word)

00-005

HVSA Expansion Application Template

English (Word)

00-002

COVID- 19 Prevention, Intervention and Quarantine Plan

English (Word)

State Fiscal Quarterly Report

English (Excel)

Provider Registration Form

English (PDF)

Provider Direct Deposit Authorization Form

English (PDF)

File Checklist (Kinship License)

English (Word)

Provider Change Form

English (PDF)

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