10-484 |
Youth Run Prevention Plan |
|
English (Word)
English (PDF)
|
|
|
11-030 |
Youth and Young Adult Housing Response Team Referral |
|
English (Word)
|
|
|
17-063 |
Written Authorization |
|
English (Word)
English (PDF)
Amharic (PDF)
Vietnamese (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)
|
|
|
19-015 |
Workforce Retention Grant Verification Form |
|
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
|
16-217 |
Washington State ICPC Quarterly Supervision Report |
|
English (Word)
English (PDF)
|
|
|
23-041 |
Washington State Child Abuse and Neglect Founded Findings Request from Another State |
|
English (Word)
English (PDF)
|
|
|
09-121 |
Waiver of Right to Receive Written Information on Adoption Support Program Limitation |
|
English (Word)
English (PDF)
|
|
|
09-054 |
Waiver of Notice of Further Hearing |
|
English (Word)
English (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)
|
|
|
02-031 |
WA State Citizen Review Panels (CRP) Data Request Form |
|
English (Word)
|
|
|
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)
|
|
|
15-363C |
Visit Coordination Plan |
|
English (Word)
English (PDF)
|
|
|
09-008 |
Victim/Witness Notification Program Enrollment (save to your computer before filling out) |
|
English (PDF)
|
|
|
05-036 |
Verification of ECEAP Eligibility |
04-2024 |
English (Word)
|
|
|
09-013 |
Vendor Affidavit of Lost, Stolen or Destroyed Warrant |
02-2022 |
English (Word)
English (PDF)
Portuguese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-455 |
Vaccine Exemption |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
15-822a |
Vaccine Agreements Certified Respite |
|
English (Word)
English (Word)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
10-462 |
User Application and Acknowledgement |
|
English (Word)
English (PDF)
|
|
|
15-454 |
Unusual Incident Report |
|
English (Word)
|
|
|
02-026 |
Unsung Hero Nomination Form |
|
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
|
15-280 |
Unlicensed Caregiver Placement Checklist |
06-2023 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-820 |
Tuberculosis (TB) Screening LD |
06-2023 |
English (Word)
English (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
|
|
|
11-024 |
Tribal Fatherhood Supports Project Plan |
|
English (Word)
|
|
|
11-020 |
Tribal Fatherhood Support Program Funding Opportunity |
|
English (Word)
|
|
|
11-028 |
Tribal Fatherhood Quarterly Reports |
02-2024 |
English (Word)
|
|
|
15-945 |
Tribal Certification Request |
|
English (Word)
|
|
|
02-006 |
Treatment Foster Care Initiative (TFCI) Referral |
|
English (Word)
Treatment Foster Care Initiative (TFCI) Information
|
|
|
15-417 |
Transition Plan for Youth Exiting Care |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
14-003 |
Trainer Observation Rubric (Self Paced) |
|
English (Word)
|
|
|
14-002 |
Trainer Observation Rubric |
|
English (Word)
English (PDF)
|
|
|
14-434 |
Title IV-E Requirements for Out of State Foster Care Payments |
|
English (Word)
English (PDF)
|
|
|
14-293 |
Title IV-E Initial Eligibility Determination Income Calculation Worksheet |
|
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)
|
|
|
15-092 |
The Interstate Compact on the Placement of Children (ICPC) Placement Request |
|
English (Word)
English (PDF)
|
|
|
15-448A |
Supported Visit Report |
|
English (Word)
English (PDF)
|
|
|
10-419 |
Supervision Plan for Site Specific Conditions |
11-2022 |
English (Word)
Spanish (PDF)
Soninke (PDF)
|
|
|
15-030 |
Substance Use Disorder Professional (SUDP) Referral |
04-2024 |
English (Word)
|
|
|
11-031 |
Strengthen Families Locally Priority Project Proposal |
|
English (Word)
|
|
|
11-032 |
Strengthen Families Locally (SFL) Budget Templatae |
|
English (Excel)
|
|
|
14-438 |
Stop Work |
10-2019 |
English (Word)
Amharic (PDF)
Arabic (PDF)
Chinese (PDF)
Dari (PDF)
Oromo (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
|
02-206 |
Statement of Earnings |
|
English (Word)
English (PDF)
Albanian (PDF)
Spanish (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)
|
|
|
|
State Fiscal Quarterly Report |
|
English (Excel)
|
|
|
16-015 |
State Approved Training Concern Form |
|
English (Word)
English (PDF)
|
|
|
05-101 |
Staff Selection Criteria for Evidence Based Practices (EBP's) |
03-2024 |
English (Word)
|
|
|
16-031 |
Staff Classroom Attendance Log |
04-2024 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
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)
|
|
|
07-112 |
Spring 2021 Child Care COVID -19 Grant Receipt Verification |
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
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)
|
|
|
14-281 |
Source of Funds Application for Child in Placement |
|
English (Word)
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)
|
|
|
15-452 |
Sibling Visit Report |
|
English (Word)
English (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)
|
|
|
15-707 |
School-Age Child Care Monitoring Checklist |
|
English (Word)
English (PDF)
|
|
|
09-093 |
School Notification |
10-2023 |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
15-944 |
School Based and Military Certification for Payment Only Request |
|
English (Word)
|
|
|
15-980 |
School Age License Application |
01-2024 |
English (Word)
English (PDF)
|
|
|
15-965 |
Sanitizer Disinfectant Approval Request |
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
15-889 |
Sample Application for Employment or Volunteer Services Licensed or Certified Early Learning/Child Care Program |
|
English (Word)
English (PDF)
|
|
|
15-859 |
Safety Record and Evacuation Plan |
|
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
15-258B |
Safety Plan |
05-2023 |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
15-258 |
Safety Assessment / Safety Plan Combined |
05-2023 |
English (Word)
Haitian-Creole (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Trukese (PDF)
Trukese (PDF)
|
|
|
15-258A |
Safety Assessment |
|
English (Word)
|
|
|
09-127 |
Rights of Children and Youth in Foster Care |
|
English (Word)
English (PDF)
|
|
|
15-309 |
Returning Child De-Briefing |
|
English (Word)
English (PDF)
|
|
|
08-050 |
Request/Certification of Data Destruction |
|
English (Word)
English (PDF)
|
|
|
15-412 |
Request for Extension and Disability Verification for Youth Over Age 18 |
|
English (Word)
English (PDF)
|
|
|
09-164 |
Request for Early Learning Background Check Results |
03-2024 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
17-041A |
Request for DCYF Records |
02-2024 |
English (Word)
English (PDF)
|
|
|
09-012 |
Request for Certificate of Parental Improvement (CPI) |
|
English (Word)
English (PDF)
|
|
|
09-611 |
Release and Consent for Child Specific Recruitment |
|
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
09-134 |
Relative Inquiry |
|
English (PDF) Download and save to desktop before filling in form.
Marshallese (PDF)
Trukese (PDF)
|
|
|
16-179 |
Reference Questionnaire Request |
|
English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
10-425 |
Reference Questionnaire (Certified Respite) |
|
English (Word)
Spanish (Word)
Spanish (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)
|
|
|
10-035 |
Receiving Care Transition Summary |
12-2023 |
English (Word)
|
|
|
11-029 |
Quarterly Reporting Tool - Stengthen Families Locally |
|
English (Excel)
|
|
|
15-028 |
Psychological Services Referral |
|
English (Word)
English (PDF)
|
|
|
15-029 |
Psychiatric Services Referral |
|
English (Word)
English (PDF)
|
|
|
|
Provider Registration Form |
|
English (PDF)
|
|
|
15-363B |
Provider Notification of Visit/Transport Schedule Initial Intake Screening Report |
|
English (Word)
English (PDF)
|
|
|
06-097 |
Provider File Action Request |
|
English (Word)
English (PDF)
|
|
|
14-435 |
Provider Employment Eligibility Verification |
|
English (Word)
English (PDF)
|
|
|
|
Provider Direct Deposit Authorization Form |
|
English (PDF)
|
|
|
|
Provider Change Form |
|
English (PDF)
|
|
|
05-003 |
Provider Application Form |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
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)
|
|
|
10-540 |
Project SafeCare Monthly Summary |
|
English (Word)
English (PDF)
|
|
|
15-027 |
Professional Services Referral |
|
English (Word)
English (PDF)
|
|
|
06-025 |
Professional Services Billing Statement |
|
English (Word)
English (PDF)
|
|
|
15-896 |
Probation Notification Letter to Parents from Provider |
|
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
|
|
|
10-586 |
Preauthorization for In-Home Services |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
15-469 |
Pre-Contract Action Request (P-CAR) |
|
English (Word)
English (PDF)
|
|
|
10-214 |
Pre-Authorization For Services |
|
English (Word)
English (PDF)
|
|
|
09-165 |
Portable Background Check Application |
03-2024 |
English (PDF)
|
|
|
10-045B |
Policies and Procedures for Group Care |
|
|
|
|
10-045 |
Policies and Procedures for Child Placing Agency (CPA) Foster Care |
|
|
|
|
10-045A |
Policies and Procedures for Child Placing Agency (CPA) Adoption Only |
|
|
|
|
15-852 |
Plan to Meet Experience Qualification |
|
English (Word)
English (PDF)
Somali (PDF)
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)
|
|
|
15-281 |
Placement Agreement |
07-2023 |
English (Word)
Arabic (PDF)
Chinese (PDF)
Russian (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
16-235 |
Photo, Video or Audio Release Waiver |
|
English (PDF)
Chinese (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
09-007 |
Petition for Review of Initial Decision (Appeal) |
|
English (Word)
English (PDF)
|
|
|
15-826 |
Pet Vaccination Agreement |
06-2023 |
English (Word)
English (PDF)
Maay Maay (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
|
|
|
15-823 |
Pertussis Vaccination Agreement |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
|
|
|
15-276 |
Personal Information |
|
English (WORD)
Marshallese (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tagalog (PDF)
Tigrigna (PDF)
Trukese (PDF)
|
|
|
11-016 |
Perinatal Mental Health Year-End Community Report Template |
|
English (Word)
|
|
|
11-018 |
Perinatal Mental Health Returning Program |
04-2024 |
English (Word)
|
|
|
15-260 |
Parents Information Sheet for Shared Planning Meetings and Staffings |
|
English (Word)
English (PDF)
|
|
|
16-010 |
Parental Advisory Group (PAG) Cover Letter and Application |
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
Spanish (Word)
|
|
|
15-857 |
Parent/Provider Health Safety Agreement (FFN) |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
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)
|
|
|
05-031 |
Parent Consent to Transfer ELMS Records |
|
English (Word)
English (PDF)
Spanish (PDF)
|
|
|
02-003b |
Parent Advisory Group (PAG) Application |
|
English (Word)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
16-190 |
Overnight Youth Shelter Checklist |
01-2019 |
English (Word)
|
|
|
15-895 |
Overnight Child Care Planning Guide |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
15-835 |
Outdoor Nature-Based Child Care License or Certification Application |
01-2024 |
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
|
11-027 |
Option 2 |
|
English (Excel)
|
|
|
11-026 |
Option 1B |
|
English (Excel)
|
|
|
11-025 |
Option 1A |
|
English (Excel)
|
|
|
15-845 |
ONB Monitoring Checklist (Example) |
|
English (Word)
|
|
|
15-841 |
ONB Initial Checklist for Applicant |
|
English (Word)
|
|
|
15-434 |
On-Going Mental Health (OMH) Screening Report |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
14-005 |
OJJDP Title II Pass Through Fund |
|
English (Word)
|
|
|
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)
|
|
|
15-402 |
Notice to Foreign Consulate of Child Protection Proceedings |
|
English (Word)
English (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)
|
|
|
15-057 |
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)
|
|
|
15-054 |
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)
|
|
|
14-040 |
Non ECEAP Child Request for ECLIPSE Enrollment |
02/2024 |
English (Word)
|
|
|
15-956 |
No Social Security Card Declaration |
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
09-154 |
NCIC Purpose Code C Background Check Summary |
|
English (Word)
English (PDF)
|
|
|
15-893 |
Multiple Licenses Request Form |
|
English (Word)
|
|
|
15-308 |
Missing Child Staffing |
|
English (Word)
English (PDF)
|
|
|
15-451 |
Missed and No Show Report: Parent – Child Visit |
|
English (Word)
English (PDF)
|
|
|
15-860 |
Medication Permission Form For Illness and Allergies (FFN) |
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
10-455 |
Medication Log |
02-2024 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
16-188 |
Medically Fragile and Children with Intellectual and Developmental Disabilities Checklist |
01-2019 |
English (Word)
|
|
|
16-184 |
Maternity Services Checklist |
01-2019 |
English (Word)
|
|
|
15-322 |
Long Term Care Agreement for Foster Parents or Relative Caregivers |
|
English (Word)
English (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
09-126 |
Local Indian Child Welfare Advisory Committee Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
15-245 |
LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-411A |
Licensing Waiver (Foster Home) |
|
English (Word)
|
|
|
05-041 |
Licensing Dvisions Practice Change Request Review & Approval |
|
English (Word)
|
|
|
05-041A |
Licensing Division Practice Change Request |
|
English (Word)
|
|
|
15-349a |
Kinship Respite Overcapacity WAC 110-148-1390 |
|
English (Word)
|
|
|
15-411G |
Kinship License Non-Safety Exemption/Waiver (Licensed Home) |
|
15-411G.docx
|
|
|
15-827 |
Kinship Caregiver iPad Equipment Checkout Agreement |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
20-015 |
Juvenile Rehabilitation Youth Engagement Request |
|
English (Word)
|
|
|
20-270 |
Juvenile Justice System Improvement Technical Assistance Grant Application |
|
English (Word)
|
|
|
20-016 |
JR Marriage Approval for Release of Information |
|
English (Word)
English (PDF)
|
|
|
20-017 |
JR Marriage Application |
|
English (Word)
English (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)
|
|
|
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)
|
|
|
10-539 |
Interstate Compact for the Placement of Children (ICPC) Reference Questionnaire for Parent Home Study |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-416 |
Interstate Compact for Adoption Medical Assstance ICAMA |
|
English (Word)
|
|
|
14-600 |
Interim Individualized Family Service Plans (IFSP) (ESIT) |
|
English (Word)
|
|
|
15-720 |
Interest Survey for Organization License Pilot |
|
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
15-853 |
Intent to Transfer License or Certification |
|
English (Word)
English (PDF)
Somali (Word)
Somali (fillable PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
10-395 |
Intensive Family Service Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary |
|
English (Word)
English (PDF)
|
|
|
09-539 |
Inquiry to Indian Tribe |
|
English (Word)
English (PDF)
|
|
|
10-056 |
Initial/Kinship License Request for Tribes |
03-2024 |
English (Word)
|
|
|
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)
|
|
|
15-822 |
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)
|
|
|
15-055 |
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)
|
|
|
06-166 |
Individual Training Plan |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
15-970 |
Individual Care Plan for Child in Child Care |
|
English (Word)
English (PDF)
Spanish (PDF)
|
|
|
09-761 |
Indian Identity Request |
|
English (Word)
English (PDF)
|
|
|
15-386 |
Independent Living Learning Plan and Progress Report - IL Provider |
02-2024 |
English (Word)
|
|
|
14-548 |
Independent (IL) / Transitional Living (TL) Grant Application |
|
English (Word)
English (PDF)
|
|
|
23-032 |
In-State Child Abuse and Neglect Founded Findings Request |
|
English (Word)
English (PDF)
|
|
|
09-104 |
ICPC Closure Letter |
|
English (Word)
English (PDF)
|
|
|
11-011A |
HVSA Tribal Home Visiting Funding Opportunity Letter of Intent |
|
English (Word)
|
|
|
15-016 |
HVSA Local Implementing Agency Contact Update Form |
|
English (Word)
English (PDF)
|
|
|
00-005 |
HVSA Expansion Application Template |
|
English (Word)
|
|
|
11-021 |
HV-BAT Supplemental Form |
|
English (Word)
|
|
|
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)
|
|
|
10-043 |
Home Study |
12-2023 |
English (Word)
Amharic (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
|
10-183 |
Home Inspection Checklist (Licensed) |
|
English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
10-453 |
Home Inspection Checklist (Kinship) |
|
English (Word)
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)
|
|
|
09-100 |
Hiring Education Affidavit Request (Early Learning) |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-209A |
Health/Mental Health and Education Summary |
|
English (Word)
English (PDF)
|
|
|
13-200 |
Health & Safety Checklist |
|
English (Word)
|
|
|
02-020 |
Guide to Background Checks |
|
English (PDF)
|
|
|
15-324 |
Guardianship Approval Checklist |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
10-055 |
Group Receiving Center Checklist |
|
|
|
|
16-189 |
Group Home Checklist |
01-2019 |
English (Word)
|
|
|
09-133 |
Group Care Background Check Request/Decision Form |
10-2023 |
English (Word)
English (PDF)
|
|
|
05-002 |
Funding Organization Commitment |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (PDF0
Spanish (Word)
|
|
|
11-023 |
FRC Quarterly Report Form |
02-2024 |
English (Word)
|
|
|
03-492 |
Foster Parent Recipient Shared Leave |
|
English (Word)
English (PDF)
|
|
|
03-493 |
Foster Parent Donor Shared Leave |
|
English (Word)
English (PDF)
|
|
|
10-405 |
Foster Home Reassessment |
|
English (Word)
|
|
|
10-405B |
Foster Home Move Reassessment |
|
English (Word)
|
|
|
10-416 |
Foster Home Monitoring Visit |
|
English (Word)
Spanish (PDF)
Spanish (Word)
|
|
|
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)
|
|
|
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)
|
|
|
09-082 |
Five Day Notification to Move |
|
English (Word)
English (PDF)
|
|
|
15-892 |
Fire, Safety, Emergency Drills Record |
|
English (Word)
Somali (PDF)
Spanish (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)
|
|
|
10-016 |
File Checklist and Certification for License of Foster Home |
03-2024 |
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)
|
|
|
|
File Checklist (Kinship License) |
|
English (Word)
|
|
|
10-182 |
File Checklist (Foster License) |
|
English (Word)
|
|
|
16-225 |
File Checklist (Certified Respite) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
15-705 |
FFN Waiver Request |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
17-251 |
FERPA Access Request |
|
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)
|
|
|
10-463 |
FamLink Data Access Request / Change |
|
English (Word)
English (PDF)
|
|
|
10-464 |
FamLink Access Application and Acknowledgement |
|
English (Word)
English (PDF)
|
|
|
15-448 |
Family Time Report |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
11-022 |
Family Resource Center Capacity Building Work Plan |
|
English (Word)
|
|
|
11-014 |
Family Resource Center Capacity Building Funding Opportunity |
|
English (Word)
|
|
|
15-709 |
Family Home Child Care Monitoring Checklist (Example) |
|
English (Word)
|
|
|
15-894 |
Family Home Child Care Liability Insurance Form |
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish PDF)
|
|
|
15-949 |
Family Home Child Care Background Checklist |
09-2023 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
15-955 |
Family Home and Center Child Care License or Certification Application |
01-2024 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
13-041 |
Family Genetic and Medical History |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
10-545 |
Family Feedback Questionnaire |
|
English (Word)
English (PDF)
|
|
|
04-220 |
Family Ancestry Chart |
|
English (Word)
English (PDF)
|
|
|
03-415 |
Facility Short Term Use Application |
|
English (Word)
English (PDF)
|
|
|
15-431 |
Extended Foster Care Program Voluntary Placement Agreement (VPA) |
|
English (Word)
English (PDF)
Dari (PDF)
French (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
10-432 |
Extended Foster Care Program Participation Agreement |
|
English (Word)
English (PDF)
French (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
06-165 |
Extended Foster Care (EFC) Denial Letter |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
14-545 |
Extended Adoption Support Application |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
05-001 |
Expression of Interest |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
05-060 |
Evidence Based Readiness Assessment |
08-2023 |
English (Word)
|
|
|
15-005 |
ESIT Health Care Referral Form |
|
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)
|
|
|
15-372 |
Enumeration Referral |
|
English (Word)
English (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)
|
|
|
14-001 |
Employment Verification for State Training |
07-2021 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
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)
|
|
|
09-132 |
Employee Background Check Request/Decision |
|
English (Word)
English (PDF)
|
|
|
16-183 |
Emergency Respite Center Checklist |
01-2019 |
English (Word)
|
|
|
10-036 |
Emergency Placement Services (EPS) Transition Summary |
01-2024 |
English (Word)
|
|
|
15-858 |
Emergency Contact and Permission Form (FFN) |
|
English (Word)
Somali (fillable PDF)
Spanish (fillable 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)
|
|
|
16-005 |
Electronice Attendance Provider Welcome Letter (Barcode) |
|
English (Word)
English (PDF)
|
|
|
06-010 |
Electronic Attendance System Vendor Approved Checklist |
|
English (Word)
English (PDF)
|
|
|
05-005 |
Education Appeal |
|
English (Word)
English (PDF)
|
|
|
06-179 |
Education and Training Voucher (ETV) Spending Plan |
|
English (Excel)
|
|
|
15-370 |
Education and Training Voucher (ETV) Program Payment Request |
|
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)
|
|
|
15-377 |
Education and Training Voucher (ETV) Program Dual Credit Application |
|
English (Word)
|
|
|
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)
|
|
|
15-369 |
Education and Training Voucher (ETV) Program 2024 - 2025 Renewal Application |
08-2023 |
English (Word)
|
|
|
05-027 |
ECLIPSE Services Application Packet |
|
Exhibit D: Startup Budget
Exhibit E: ECLIPSE Services Application Form
Exhibit F: Certifications and Assurances
|
|
|
05-034 |
ECLIPSE RFA Applications and Guides |
|
Request for Application References
Budget Form
ECLIPSE Request for Application Guide
ECLIPSE Minimum Service Delivery Requirements Table
|
|
|
05-037 |
ECLIPSE Prioritization Worksheet |
04-2024 |
English (Word)
|
|
|
05-007A |
ECEAP Services Carryforward Plan |
|
English (Excel)
|
|
|
07-020 |
ECEAP Service Purchase Request |
|
English (Word)
English (PDF)
|
|
|
23-046 |
ECEAP Program Monitoring Community Partner Questionnaire |
|
English (Word)
English (PDF)
|
|
|
05-010 |
ECEAP Professional Development Plan Lead Teacher |
|
English (Word)
English (PDF)
|
|
|
05-009 |
ECEAP Professional Development Plan Assistant Teacher |
|
English (Word)
English (PDF)
|
|
|
05-006 |
ECEAP Pre-screen & Application (Combined Form) |
03-2024 |
English_2024-2025
Amharic_2024-2025
Arabic_2024-2025
Dari_2024-2025
Korean_2024-2025
Russian_2024-2025
Somali_2025-2025
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
|
|
|
05-325 |
ECEAP Porgram Monitoring Document Review Checklist |
|
English (Word)
English (PDF)
|
|
|
05-007 |
ECEAP Contractor Financial Disclosure Certification |
|
English (PDF)
|
|
|
05-024 |
ECEAP Contractor Equipment Disposal Request |
|
English (Word)
English (PDF)
|
|
|
05-021 |
ECEAP Contractor Alternative Attendance Plan Request |
|
English (Word)
English (PDF)
|
|
|
05-022 |
ECEAP Contract Waiver-Variance Request to ECEAP Requirements |
|
English (Word)
|
|
|
05-032 |
ECEAP Complex Needs Fund Application FY 2024-25 |
|
English (Word)
|
|
|
05-004 |
ECEAP Community Funded |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (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
|
|
|
05-035 |
ECEAP & Early ECEAP Parent & Family Voices (PFV) PFV Representative ("Rep") Recruitment |
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
10-083 |
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment |
|
English (Word)
English (PDF)
|
|
|
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)
|
|
|
10-475 |
Early Invention Program (EIP) Exit Summary |
|
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)
|
|
|
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
|
|
|
14-255 |
Early Childhood Equity Grant Application |
02-2024 |
English (Word)
|
|
|
07-112a |
Early Achievers Needs-Based Grant Receipt Verification Form |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
14-025 |
Early Achievers Extension Application |
|
English (Word)
Somali (Word)
Spanish (Word)
|
|
|
09-026 |
DSO & Jail Removal Data Form |
|
English (Word)
|
|
|
06-172 |
Domestic Violence Prevention Account |
|
English (Word)
English (PDF)
|
|
|
09-837 |
Disclosure of Confidential HIV / AIDS Information |
|
English (Word)
English (PDF)
|
|
|
11-017 |
Diaper Bank Partnership Quarterly Report Form |
|
English (Word)
|
|
|
11-019 |
Diaper Bank Concrete Good for Families Quarterly Report Form |
|
English (Word)
|
|
|
13-904 |
Diabetes Care and Action Plan |
|
English (Word)
English (PDF)
|
|
|
09-056 |
Dependent/Ward of the Court Verification |
|
English (Word)
English (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
|
|
|
14-446 |
Declaration of Financial Status for Adoption Support Application |
|
English (Word)
English (PDF)
|
|
|
15-703 |
Declaration of Compliance (for Outdoor Nature-Based Programs) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
15-974 |
Declaration of Compliance |
12-2023 |
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
09-765 |
Declaration of Adoption Facilitator - Indian Child |
04-2023 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-470 |
DCYF Regional Contract 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)
|
|
|
10-454 |
DCYF Caregiver Authorization |
|
English (PDF)
Laotian (PDF)
Mam (fillable PDF)
Spanish (fillable PDF)
|
|
|
15-942 |
Daily Child Attendance Records |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
16-186 |
Crisis & Secured Crisis Residential Checklist |
01-2019 |
English (Word)
|
|
|
00-002 |
COVID- 19 Prevention, Intervention and Quarantine Plan |
|
English (Word)
|
|
|
10-459 |
Courtesy Supervision Referral |
|
English (Word)
English (PDF)
|
|
|
16-025 |
Contractor Certification |
|
English (Word)
|
|
|
10-567 |
Contracted Health and Safety Visit Report |
|
English (Word)
English (PDF)
|
|
|
10-566 |
Contracted Health and Safety Visit Referral |
|
English (Word)
English (PDF)
|
|
|
15-466 |
Contract Risk Assessment / Analysis |
|
English (PDF)
|
|
|
09-111 |
Continuous Quality Improvement Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
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)
|
|
|
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)
|
|
|
15-362 |
Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home |
|
English (Word)
English (PDF)
|
|
|
10-480 |
Comprehensive Family Evaluation |
|
English (Word)
English (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)
|
|
|
05-061 |
Combined In-Home Service (CIHS) Inquiry |
03-2024 |
English (Word)
|
|
|
05-100 |
Combined IN-Home Contracts: Semi-Annual Quality Assurance Report |
03-2024 |
English (Word)
|
|
|
|
Combined In-Home Contracts: Semi-Annual Quality Assurance Report |
03-2024 |
English (Word)
|
|
|
07-085 |
Client Travel Approval Quick Reference Guide |
03-2024 |
English (PDF)
|
|
|
05-050 |
Citizen Review Panel Membership Application |
|
English (Word)
|
|
|
05-051 |
Citizen Review Panel Confidentiality Agreement |
|
English (Word)
|
|
|
23-035 |
CHINS/ARY Report to Juvenile Court |
|
English (Word)
English (PDF)
|
|
|
15-891 |
Chimney, Fireplace, Woodstove Use Statement |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
10-061 |
Child’s Registration |
|
English (Word)
English (PDF)
|
|
|
15-359 |
Child's Physical Description |
|
English (Word)
English (PDF)
|
|
|
09-010 |
Child Welfare History |
|
English (Word)
|
|
|
10-490 |
Child Specific Contract or Extra Supervision Rate Proposal |
|
English Excel
|
|
|
15-450 |
Child Specific Caregiver Notification |
|
English (Word)
English (PDF)
|
|
|
10-042 |
Child Protective Services Casework Checklist |
|
English (Word)
English (PDF)
|
|
|
15-266 |
Child Protect Teams (CPT) Staffing Recommendations |
|
English (Word)
English (PDF)
|
|
|
15-268 |
Child Protect Teams (CPT) Case Presentation Summary |
|
English (Word)
English (PDF)
|
|
|
23-036 |
Child Placing Agency Foster Home Licensing Investigation |
|
English (Word)
|
|
|
09-129 |
Child Near Fatality Case Review Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
15-899 |
Child Licensee or Assistant Resume |
|
English (Word)
English PDF)
Somali (PDF)
|
|
|
15-300 |
Child Information and Placement Referral |
|
English (Word)
English (PDF)
|
|
|
14-444 |
Child Health and Education Tracking Screening Report |
09-2023 |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
09-128 |
Child Fatality Case Review Confidentiality Agreement |
|
English (Word)
English (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)
|
|
|
15-015 |
Child Care Subsidy Program Site Change Form |
|
English (Word)
English (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)
|
|
|
15-879 |
Child Care Registration (fh/ctr) |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
15-897 |
Child Care Parent Guardian Permissions |
|
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
|
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)
|
|
|
15-941 |
Child Care Injury Incident Report |
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Spanish (Word)
|
|
|
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)
|
|
|
07-035 |
Child Care Complex Needs Fund Verification |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
15-937 |
Child Care Center School-Age Background Checklist |
01-2024 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
15-708 |
Child Care Center Monitoring Checklist (Example) |
|
English (Word)
|
|
|
15-943 |
Child Care Agreement |
|
English (Word)
Spanish (Word)
|
|
|
23-033 |
Child Abuse and Neglect Information Request |
|
English (Word)
English (PDF)
|
|
|
14-011a |
Change Form Medical and Dental Benefits |
|
English (PDF)
Spanish (fillable PDF)
Somali (fillable PDF)
|
|
|
14-510 |
Certified Respite Provider Agreements |
|
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
05-250 |
Certification Regarding Environmental Tobacco Smoke |
|
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)
|
|
|
11-015 |
CBCAP Returning Programs |
04-2024 |
English (Word)
|
|
|
04-225 |
CBCAP Quarterly Report |
08-2023 |
English (Word)
Spanish (Word)
Spanish (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)
|
|
|
15-313A |
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)
|
|
|
10-428 |
Caregiver Support Plan |
|
English (Word)
English (PDF)
|
|
|
07-090 Contact Forms Manager for translation revisions |
Caregiver Monthly Transportation Reimbursement |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
15-874 |
Capacity Increase Change Planning Guide |
|
English (Word)
English (PDF)
|
|
|
10-046B |
Budget for Group Care |
|
|
|
|
10-046 |
Budget for Child Placing Agency (CPA) |
|
|
|
|
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)
|
|
|
16-030 |
Book Review Worksheet for Foster Parent Training Hours |
|
English (Word)
Spanish (Word)
Spanish (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)
|
|
|
10-166A |
Behavioral Rehabilitation (BRS) Referral |
|
English (Word)
English (PDF)
|
|
|
15-460 |
Background Confirmation and Out of State Check |
03-2024 |
English (Word)
|
|
|
23-037 |
Background Clearance Notification |
|
English (Word)
|
|
|
09-131 |
Background Check Request/Decision |
|
English (Word)
English (PDF)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
09-162 |
Background Check Reconsideration Request |
|
English (Word)
English (PDF)
|
|
|
09-160 |
Background Check Hearing Request Form |
|
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)
|
|
|
09-966 |
Authorization to Release Information to the Court |
|
English (Word)
English (PDF)
|
|
|
09-031 |
Authorization By Subject of Records Requested |
|
English (Word)
English (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)
|
|
|
15-824 |
Authorization and Consent to Share Records |
|
English (Word)
Spanish (Word)
Spanish (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
|
15-267 |
Attendance and Confidentiality Agreement |
|
English (Word)
English (PDF)
Vietnamese (PDF)
|
|
|
16-209 |
Archived Records Memo Adoption and/or Legally Free Children Aged Out |
|
English (Word)
English (PDF)
|
|
|
05-012 |
Approval of New Early ECEAP Site/Classroom |
|
English (Word)
|
|
|
05-033 |
Approval of New B-5 Subcontractos (ECEAP) 2023-2024 |
|
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)
|
|
|
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)
|
|
|
10-408 |
Application for Child Care Agency License or Certification |
|
English (Word)
English (PDF)
|
|
|
14-512 |
Application for Certified Respite Provider |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable 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)
|
|
|
03-374B |
Agreement on Nondisclosure of Confidential Information-Non Employee |
|
English (Word)
English (PDF)
|
|
|
15-472 |
After-the-Fact Contract Justification |
|
English (Word)
|
|
|
15-286A |
Adult Child Reference Questionnaire |
|
English (Word)
English (PDF)
Arabic (PDF)
Marshallese (PDF)
Spanish (PDF)
Tagalog (PDF)
|
|
|
10-606 |
Adoptive Parent Counseling Preauthorization for Services |
|
English (Word)
English (PDF)
|
|
|
09-997 |
Adoption Support Worksheet |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
10-477 |
Adoption Support Program Application Checklist |
|
English (Word)
English (PDF)
|
|
|
06-160 |
Adoption Support Monthly Counseling Billing |
|
English (Word)
English (PDF)
|
|
|
10-082 |
Adoption Support Modification Worksheet |
01-2024 |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
15-425 |
Adoption Redaction Request |
|
English (Word)
English (PDF)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
15-060 |
Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report |
|
English (Word)
|
|
|
10-114 |
Adoption Data Card |
|
English (Word)
English (PDF)
|
|
|
10-546 |
Adoption Archive Request for Non-Identifying Information |
|
English (Word)
English (PDF)
|
|
|
15-411D |
Administrative Approval (Foster Home) |
|
English (Word)
|
|
|
05-305 |
ADA/504 Discrimination Complaint/Grievance Form |
|
English (PDF)
|
|
|
20-020 |
Acknowledgement of JR Policy 6.70 Marriage in JR Facilities |
|
English (Word)
English (PDF)
|
|
|
10-500 |
Acknowledgement of Child’s Adoptive File Provided to Adoptive Family: |
|
English (Word)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
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)
|
|
|
11-011 |
2022 Spring HVSA Expansion Funding Opportunity Letter of Intent to Apply |
|
English (Word)
|
|
|
05-320 |
2018-19 Financial Disclosure Certification |
|
English (PDF)
|
|
|
10-537 |
Interstate Compact for the Placement of Children (ICPC) Parent Home Study Information |
|
10-537
10-537
Spanish (PDF)
Spanish (Word)
|
|
|