|
15-005
|
ESIT Health Care Referral Form
|
|
English (Word)
English (PDF)
|
|
|
|
15-015
|
Child Care Subsidy Program Site Change Form
|
|
English (Word)
English (PDF)
|
|
|
|
15-016
|
HVSA Local Implementing Agency Contact Update Form
|
|
English (Word)
English (PDF)
|
|
|
|
15-027
|
Professional Services Referral
|
|
English (Word)
English (PDF)
|
|
|
|
15-028
|
Psychological Services Referral
|
|
English (Word)
English (PDF)
|
|
|
|
15-029
|
Psychiatric Services Referral
|
|
English (Word)
English (PDF)
|
|
|
|
15-030
|
Substance Use Disorder Professional (SUDP) Referral
|
04-2024
|
English (Word)
|
|
|
|
15-050
|
Confirmation of Individualized Family Service Plan (IFSP) Schedule
|
07-2021
|
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)
Tigrigna (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-051
|
Declining One or More Early Intervention Services
|
|
English
Amharic (PDF)
Arabic
Cambodian
Chinese
Farsi
Korean
Laotian
Punjabi (PDF)
Russian
Somali
Spanish
Tamil
Telugu (PDF)
Ukrainian (PDF)
Urdu
Vietnamese
|
|
|
|
15-052
|
Declining Participation in the ESIT Program
|
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-053
|
Formal Dispute Resolution Request
|
10-2024
|
English (PDF)
አማርኛ- Amharic
عربي - (Arabic)
বাংলা - (Bengali)
កម្ពុជា។ - (Cambodian)
中文 - (Chinese)
Dari
فارسی - (Farsi)
Français - (French)
हिन्दी - (Hindi)
한국인 - (Korean)
ພາສາລາວ -( Laotian)
Kajinَ Majōlَ - (Marshallese)
Afaan Oromoo - (Oromo)
و ښ ت پ - (Pashtu)
Punjabi (PDF)
русскийَ - (Russian)
Af-Soomaali - (Somali)
Español - (Spanish fillable)
Tagalog
தமிழ் - (Tamil)
తెలుగు - (Telugu)
ትግርኛ (Tigrigna)
Українська - (Ukrainian)
Urdu (PDF)
Tiếng Việt - (Vietnamese)
|
|
|
|
15-054
|
Notice and Consent for Evaluation/Assessment
|
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-055
|
Individualized Family Service Plan (IFSP)
|
08-2021
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Japanese (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Telugu (PDF)
Tamil (PDF)
Tigrigna (PDF)
Ukranina (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-056
|
Notice of Consent for Initial Evaluation Assessment
|
11-2021
|
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)
Tigrigna (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-057
|
Notice and Consent for Screening
|
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-058
|
Parent Prior Written Notice
|
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)
Tigrigna (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
|
15-059
|
Prior Written Notice Consent and Financial Information Forms
|
01-2019
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Japanese (PDF)
Korean (PDF)
Laotian (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Tigrigna (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese
|
|
|
|
15-060
|
Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report
|
|
English (Word)
|
|
|
|
15-092
|
The Interstate Compact on the Placement of Children (ICPC) Placement Request - 100A
|
|
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
|
02-2023
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-209A
|
Health/Mental Health and Education Summary
|
|
English (Word)
English (PDF)
|
|
|
|
15-209C
|
Visit Plan
|
|
English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tagalog (PDF)
Tigrigna (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
|
15-210
|
Out of State Family Time Referral
|
07-2024
|
English (Word)
|
|
|
|
15-245
|
LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record
|
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-258
|
Safety Assessment / Safety Plan Combined
|
05-2023
|
English (Word)
Burmese (PDF)
French (PDF)
Haitian-Creole (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Trukese (PDF)
Trukese (PDF)
|
|
|
|
15-258A
|
Safety Assessment
|
|
English (Word)
|
|
|
|
15-258B
|
Safety Plan
|
05-2023
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-259A
|
Case Plan
|
12-2020
|
English (Word)
English (PDF)
Chinese (PDF)
Korean (PDF)
Marshallese (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
|
|
15-260
|
Parents Information Sheet for Shared Planning Meetings and Staffings
|
|
English (Word)
English (PDF)
|
|
|
|
15-266
|
Child Protect Teams (CPT) Staffing Recommendations
|
|
English (Word)
English (PDF)
|
|
|
|
15-267
|
Attendance and Confidentiality Agreement
|
|
English (Word)
English (PDF)
Vietnamese (PDF)
|
|
|
|
15-268
|
Child Protect Teams (CPT) Case Presentation Summary
|
|
English (Word)
English (PDF)
|
|
|
|
15-276
|
Personal Information
|
09-2022
|
English (WORD)
Bosnian (PDF)
Korean (PDF)
Marshallese (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tagalog (PDF)
Tigrigna (PDF)
Trukese (PDF)
|
|
|
|
15-280
|
Unlicensed Caregiver Placement Checklist
|
06-2023
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-281
|
Placement Agreement
|
07-2023
|
English (Word)
Arabic (PDF)
Chinese (PDF)
Dari (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (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)
|
|
|
|
15-286A
|
Adult Child Reference Questionnaire
|
|
English (Word)
English (PDF)
Arabic (PDF)
Marshallese (PDF)
Spanish (PDF)
Tagalog (PDF)
|
|
|
|
15-300
|
Child Information and Placement Referral
|
|
English (Word)
English (PDF)
|
|
|
|
15-308
|
Missing Child Staffing
|
|
English (Word)
English (PDF)
|
|
|
|
15-309
|
Returning Child De-Briefing
|
|
English (Word)
English (PDF)
|
|
|
|
15-313
|
Caregiver's Report to the Court
|
06-2023
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-313A
|
Caregiver's Report to the Court (Abbreviated)
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-314
|
Combined In-Home Service Monthly Report
|
08-2024
|
English (Word)
|
|
|
|
15-315
|
Transition Plan Meeting
|
08-2024
|
English (Word)
|
|
|
|
15-322
|
Long Term Care Agreement for Foster Parents or Relative Caregivers
|
|
English (Word)
English (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-324
|
Guardianship Approval Checklist
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-349a
|
Kinship Respite Overcapacity WAC 110-148-1390
|
|
English (Word)
|
|
|
|
15-359
|
Child's Physical Description
|
|
English (Word)
English (PDF)
|
|
|
|
15-362
|
Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home
|
|
English (Word)
English (PDF)
|
|
|
|
15-363B
|
Provider Notification of Visit/Transport Schedule Initial Intake Screening Report
|
|
English (Word)
English (PDF)
|
|
|
|
15-363C
|
Visit Coordination Plan
|
|
English (Word)
English (PDF)
|
|
|
|
15-368
|
Education and Training Voucher (ETV) Program Participation Agreement
|
11-2024
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-368A
|
Education and Training Voucher (ETV) Program Dual Credit Participation Agreement
|
11-2024
|
English (PDF)
English (Word)
|
|
|
|
15-369
|
Education and Training Voucher (ETV) Program 2025 - 2026 Renewal Application
|
11-2024
|
English (Word)
|
|
|
|
15-370
|
Education and Training Voucher (ETV) Program Payment Request
|
|
English (Word)
English (PDF)
|
|
|
|
15-372
|
Enumeration Referral
|
|
English (Word)
English (PDF)
|
|
|
|
15-377
|
Education and Training Voucher (ETV) Program Dual Credit Application
|
11-2024
|
English (Word)
|
|
|
|
15-386
|
Independent Living Learning Plan and Progress Report - IL Provider
|
04-2025
|
English (Word)
|
|
|
|
15-402
|
Notice to Foreign Consulate of Child Protection Proceedings
|
|
English (Word)
English (PDF)
|
|
|
|
15-411G
|
Kinship License Non-Safety Exemption/Waiver (Licensed Home)
|
05-2023
|
English (Word)
Spanish (Word)
Spanish (PDF)
Trukese (PDF)
|
|
|
|
15-412
|
Request for Extension and Disability Verification for Youth Over Age 18
|
|
English (Word)
English (PDF)
|
|
|
|
15-416
|
Interstate Compact for Adoption Medical Assstance ICAMA
|
|
English (Word)
|
|
|
|
15-417
|
Transition Plan for Youth Exiting Care
|
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-425
|
Adoption Redaction Request
|
|
English (Word)
English (PDF)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
|
15-428
|
Protective Action Plan
|
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Cambodian (PDF)
Chinese (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Vietnamese (PDF)
|
|
|
|
15-431
|
Extended Foster Care Program Voluntary Placement Agreement (VPA)
|
05-2024
|
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)
|
|
|
|
15-434
|
On-Going Mental Health (OMH) Screening Report
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-448
|
Family Time Report
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-448A
|
Supported Visit Report
|
|
English (Word)
English (PDF)
|
|
|
|
15-448B
|
Out of State Family Time Report
|
07-2024
|
English (Word)
|
|
|
|
15-450
|
Child Specific Caregiver Notification
|
|
English (Word)
English (PDF)
|
|
|
|
15-451
|
Missed and No Show Report: Parent – Child Visit
|
|
English (Word)
English (PDF)
|
|
|
|
15-451B
|
Out of State No Show/Cancellation Report
|
07-2024
|
English (Word)
|
|
|
|
15-452
|
Sibling Visit Report
|
|
English (Word)
English (PDF)
|
|
|
|
15-452B
|
Out of State Sibling Visit Report
|
07-2024
|
English (Word)
|
|
|
|
15-454
|
Unusual Incident Report
|
|
English (Word)
|
|
|
|
15-454A
|
Out of State Family Time Visit Unusual Incident Report
|
07-2024
|
English (Word)
|
|
|
|
15-455
|
Vaccine Exemption
|
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
|
15-460
|
Background Confirmation and Out of State Check
|
03-2024
|
English (Word)
English (PDF)
|
|
|
|
15-466
|
Contract Risk Assessment / Analysis
|
|
English (PDF)
|
|
|
|
15-469
|
Pre-Contract Action Request (P-CAR)
|
|
English (Word)
English (PDF)
|
|
|
|
15-470
|
DCYF Regional Contract Request
|
|
English (Word)
English (PDF)
|
|
|
|
15-472
|
After-the-Fact Contract Justification
|
|
English (Word)
|
|
|
|
15-489
|
Placement Entry Tool
|
|
English (Word)
English (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)
|
|
|
|
15-703
|
Declaration of Compliance (for Outdoor Nature-Based Programs)
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-705
|
FFN Waiver Request
|
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-707
|
School-Age Child Care Monitoring Checklist
|
|
English (Word)
English (PDF)
|
|
|
|
15-708
|
Child Care Center Monitoring Checklist (Example)
|
|
English (Word)
|
|
|
|
15-709
|
Family Home Child Care Monitoring Checklist (Example)
|
|
English (Word)
|
|
|
|
15-716
|
Benefit-Risk Assessment and Mitigation Development for Outdoor Nature-Based (ONB) Child Care Programs
|
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-820
|
Tuberculosis (TB) Screening LD
|
06-2023
|
English (Word)
English (PDF)
Chinese (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
|
|
|
|
15-821
|
Infant Safety Agreement
|
|
English (Word)
Chinese (PDF)
Marshellese (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
|
|
15-821a
|
Infant Safety Certified Respite
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-822
|
Influenza Vaccination Agreement
|
09-2022
|
English (Word)
Chinese (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Tigrigna (PDF)
Vietnamese (PDF)
|
|
|
|
15-822a
|
Vaccine Agreements Certified Respite
|
|
English (Word)
English (Word)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
|
15-823
|
Pertussis Vaccination Agreement
|
09-2022
|
English (Word)
English (PDF)
Chinese (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
|
|
|
|
15-824
|
Authorization and Consent to Share Records
|
11-2022
|
English (Word)
Chinese (PDF)
Korean (PDF)
Spanish (Word)
Spanish (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
|
|
15-824A
|
Authorization and Consent to Share Records (CPA Home)
|
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-824b
|
Authorization and Consent to Share Records (Child Placing Agency/Group Care Staff)
|
|
English (Word)
English (PDF)
|
|
|
|
15-826
|
Pet Vaccination Agreement
|
06-2023
|
English (Word)
English (PDF)
Maay Maay (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
|
|
|
|
15-827
|
Kinship Caregiver iPad Equipment Checkout Agreement
|
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-835
|
Outdoor Nature-Based Child Care License or Certification Application
|
01-2024
|
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
|
|
15-839
|
Family Home Child Care Capacity Waiver Request
|
04-2025
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-841
|
ONB Initial Checklist for Applicant
|
|
English (Word)
|
|
|
|
15-845
|
ONB Monitoring Checklist (Example)
|
|
English (Word)
|
|
|
|
15-852
|
Plan to Meet Experience Qualification
|
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-853
|
Intent to Transfer License or Certification
|
|
English (Word)
English (PDF)
Somali (Word)
Somali (fillable PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
|
15-857
|
Parent/Provider Health Safety Agreement (FFN)
|
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-858
|
Emergency Contact and Permission Form (FFN)
|
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
|
15-859
|
Safety Record and Evacuation Plan
|
|
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
|
15-860
|
Medication Permission Form For Illness and Allergies (FFN)
|
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
|
15-861
|
Initial Checklist for Child Care Center Applicant
|
05-2023
|
English (Word)
|
|
|
|
15-862
|
Initial Checklist for Family Home Child Care Applicant
|
05-2023
|
English (Word)
Ukrainian (PDF)
|
|
|
|
15-863
|
Initial Checklist for School-Age Program Applicant
|
05-2023
|
English (Word)
|
|
|
|
15-874
|
Capacity Increase Change Planning Guide
|
|
English (Word)
English (PDF)
|
|
|
|
15-879
|
Child Care Registration (fh/ctr)
|
06-2021
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
|
|
|
|
15-889
|
Sample Application for Employment or Volunteer Services Licensed or Certified Early Learning/Child Care Program
|
|
English (Word)
English (PDF)
|
|
|
|
15-891
|
Chimney, Fireplace, Woodstove Use Statement
|
09-2019
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
|
|
|
|
15-892
|
Fire, Safety, Emergency Drills Record
|
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-893
|
Multiple Licenses Request Form
|
|
English (Word)
|
|
|
|
15-894
|
Family Home Child Care Liability Insurance Form
|
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish PDF)
|
|
|
|
15-895
|
Overnight Child Care Planning Guide
|
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-896
|
Probation Notification Letter to Parents from Provider
|
|
English (Word)
|
|
|
|
15-897
|
Child Care Parent Guardian Permissions
|
|
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
|
|
15-899
|
Child Licensee or Assistant Resume
|
|
English (Word)
English PDF)
Somali (PDF)
|
|
|
|
15-907
|
Child Care Violation Dispute Request
|
08-2019
|
English (Word)
|
|
|
|
15-937
|
Child Care Center School-Age Background Checklist
|
01-2024
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
|
15-941
|
Child Care Injury Incident Report
|
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Spanish (Word)
|
|
|
|
15-942
|
Daily Child Attendance Records
|
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-943
|
Child Care Agreement
|
|
English (Word)
Spanish (Word)
|
|
|
|
15-944
|
School Based and Military Certification for Payment Only Request
|
|
English (Word)
|
|
|
|
15-945
|
Tribal Certification Request
|
|
English (Word)
|
|
|
|
15-949
|
Family Home Child Care Background Checklist
|
09-2023
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-952
|
Notification to Parents and Guardian - Safe Sleep Non-Compliance
|
|
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-954
|
Notification of Staffing Plan Absence
|
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-955
|
Family Home and Center Child Care License or Certification Application
|
01-2024
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
|
15-956
|
No Social Security Card Declaration
|
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-957
|
Child Care Variance Request
|
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-961
|
Child Care Waiver Request
|
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-963
|
Early Learning-Child Care Facility Feasibility Checklist
|
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-964
|
Early Learning-Child Care Facility Feasibility Checklist (sa)
|
|
English (Word)
|
|
|
|
15-965
|
Sanitizer Disinfectant Approval Request
|
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
|
15-966
|
Child Care Health Consultant Agreement
|
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-967
|
Child Care Health Consultant Onsite Report
|
|
English (Word)
Engllish (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-968
|
Child Care Medication Authorization
|
06-2021
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
|
|
|
|
15-969
|
Child Care Medication Log
|
|
Englislh (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
|
15-970
|
Individual Care Plan for Child in Child Care
|
06-2021
|
English (Word)
English (PDF)
Spanish (PDF)
Ukrainian (PDF)
|
|
|
|
15-971
|
Request for Inactive Child Care Status
|
06-2021
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
|
15-974
|
Declaration of Compliance
|
12-2023
|
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
|
15-979
|
Declaration of Items in Unlicensed Space
|
08-019
|
English (Word)
|
|
|
|
15-980
|
School Age License Application
|
01-2024
|
English (Word)
English (PDF)
|
|
|
