DCYF Forms

Find brochures & other publications on the DCYF publications library.
Number Sort descending Form Name Revision Date File Format Digital Format
State Fiscal Quarterly Report English (Excel)
Provider Change Form English (PDF)
Provider Direct Deposit Authorization Form English (PDF)
Provider Registration Form English (PDF)
File Checklist (Kinship License) English (Word)
00-002 COVID- 19 Prevention, Intervention and Quarantine Plan English (Word)
00-005 HVSA Expansion Application Template English (Word)
00-005A 2022 Spring HVSA Tribal Expansion Funding Application English (Word)
00-005b 2023 HVSA Application for Funding Home Visiting Exploration Planning English (Word)
00-020 4th Annaul DCYF Indigenous Children, Youth, and Families (ICYF) Conference English (Word)
02-003 Application for Early Learning Advisory Council English (Word)
02-003a Application for Provider Supports Subcommittee English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
02-003b Parent Advisory Group (PAG) Application English (Word)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
02-006 Treatment Foster Care Initiative (TFCI) Referral English (Word)
Treatment Foster Care Initiative (TFCI) Information
02-020 Guide to Background Checks English (PDF)
02-026 Unsung Hero Nomination Form English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
02-031 WA State Citizen Review Panels (CRP) Data Request Form English (Word)
02-206 Statement of Earnings English (Word)
English (PDF)
Albanian (PDF)
Spanish (PDF)
03-374B Agreement on Nondisclosure of Confidential Information-Non Employee English (Word)
English (PDF)
03-415 Facility Short Term Use Application English (Word)
English (PDF)
03-492 Foster Parent Recipient Shared Leave English (Word)
English (PDF)
03-493 Foster Parent Donor Shared Leave English (Word)
English (PDF)
04-220 Family Ancestry Chart English (Word)
English (PDF)
04-225 CBCAP Quarterly Report English (Word)
05-001 Expression of Interest English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
05-002 Funding Organization Commitment English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (PDF0
Spanish (Word)
05-003 Provider Application Form English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
05-004 ECEAP Community Funded English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
05-005 Education Appeal English (Word)
English (PDF)
05-006 ECEAP Pre-screen & Application (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
05-007 ECEAP Contractor Financial Disclosure Certification English (PDF)
05-007A ECEAP Services Carryforward Plan English (Excel)
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
05-009 ECEAP Professional Development Plan Assistant Teacher English (Word)
English (PDF)
05-010 ECEAP Professional Development Plan Lead Teacher English (Word)
English (PDF)
05-012 Approval of New Early ECEAP Site/Classroom English (Word)
05-021 ECEAP Contractor Alternative Attendance Plan Request English (Word)
English (PDF)
05-022 ECEAP Contract Waiver-Variance Request to ECEAP Requirements English (Word)
05-024 ECEAP Contractor Equipment Disposal Request English (Word)
English (PDF)
05-026A ECEAP and B-3 Services Application Exhibit A: ECEAP and B-3 Services Application
Exhbit B: Letters of Support and Collaboration
Exhibit C: Coordination with Neighboring Head Start/ECEAP and Tribal Organizations (Scored)
Exhibit D: Budget
Exhibit F: Certifications and Assurances
05-027 ECLIPSE Services Application Packet Exhibit D: Startup Budget
Exhibit E: ECLIPSE Services Application Form
Exhibit F: Certifications and Assurances
05-031 Parent Consent to Transfer ELMS Records English (Word)
English (PDF)
Spanish (PDF)
05-032 ECEAP Complex Needs Fund Application FY 2024-25 English (Word)
05-033 Approval of New B-5 Subcontractos (ECEAP) 2023-2024 English (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
05-035 ECEAP & Early ECEAP Parent & Family Voices (PFV) PFV Representative ("Rep") Recruitment English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
05-036 Verification of ECEAP Eligibility

04-2024

English (Word)
05-037 ECLIPSE Prioritization Worksheet

04-2024

English (Word)
05-041 Licensing Dvisions Practice Change Request Review & Approval English (Word)
05-041A Licensing Division Practice Change Request English (Word)
05-050 Citizen Review Panel Membership Application English (Word)
05-051 Citizen Review Panel Confidentiality Agreement English (Word)
05-060 Evidence Based Readiness Assessment

08-2023

English (Word)
05-061 Combined In-Home Service (CIHS) Inquiry

03-2024

English (Word)
05-101 Staff Selection Criteria for Evidence Based Practices (EBP's)

03-2024

English (Word)
05-250 Certification Regarding Environmental Tobacco Smoke English (Word)
English (PDF)
05-305 ADA/504 Discrimination Complaint/Grievance Form English (PDF)
05-320 2018-19 Financial Disclosure Certification English (PDF)
05-325 ECEAP Porgram Monitoring Document Review Checklist English (Word)
English (PDF)
06-010 Electronic Attendance System Vendor Approved Checklist English (Word)
English (PDF)
06-025 Professional Services Billing Statement English (Word)
English (PDF)
06-097 Provider File Action Request English (Word)
English (PDF)
06-160 Adoption Support Monthly Counseling Billing English (Word)
English (PDF)
06-165 Extended Foster Care (EFC) Denial Letter English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
06-166 Individual Training Plan English (Word)
Spanish (Word)
Spanish (PDF)
06-172 Domestic Violence Prevention Account English (Word)
English (PDF)
06-179 Education and Training Voucher (ETV) Spending Plan English (Excel)
07-020 ECEAP Service Purchase Request English (Word)
English (PDF)
07-035 Child Care Complex Needs Fund Verification English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
07-085 Client Travel Approval Quick Reference Guide

03-2024

English (PDF)
07-090 Contact Forms Manager for translation revisions Caregiver Monthly Transportation Reimbursement English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
07-110 Child Care Stabilization Grant Application – Family, Friend, and Neighbor (FFN) License- Exempt Providers English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
07-110A Child Care Stabilization Grant Spend Period Extension Request English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
07-110B Stabilization Grant Receipt Verification Form Program and Add-On Amounts English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
07-110C Stabilization Grant Receipt Verification Form Workforce Amounts English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
07-112 Spring 2021 Child Care COVID -19 Grant Receipt Verification English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
07-112a Early Achievers Needs-Based Grant Receipt Verification Form English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
08-050 Request/Certification of Data Destruction English (Word)
English (PDF)
09-007 Petition for Review of Initial Decision (Appeal) English (Word)
English (PDF)
09-008 Victim/Witness Notification Program Enrollment (save to your computer before filling out) English (PDF)
09-010 Child Welfare History English (Word)
09-012 Request for Certificate of Parental Improvement (CPI) English (Word)
English (PDF)
09-013 Vendor Affidavit of Lost, Stolen or Destroyed Warrant

02-2022

English (Word)
English (PDF)
Portuguese (PDF)
Spanish (Word)
Spanish (PDF)
09-026 DSO & Jail Removal Data Form English (Word)
09-031 Authorization By Subject of Records Requested English (Word)
English (PDF)
09-054 Waiver of Notice of Further Hearing English (Word)
English (PDF)
09-056 Dependent/Ward of the Court Verification English (Word)
English (PDF)
09-082 Five Day Notification to Move English (Word)
English (PDF)
09-093 School Notification

10-2023

English (Word)
Spanish (Word)
Spanish (PDF)
09-100 Hiring Education Affidavit Request (Early Learning) English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
09-101 Hiring Education Affidavit Request (School Age) English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
09-102 Hiring Education Affidavit Request (Outdoor Nature-Based) English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
09-104 ICPC Closure Letter English (Word)
English (PDF)
09-111 Continuous Quality Improvement Confidentiality Agreement English (Word)
English (PDF)
09-121 Waiver of Right to Receive Written Information on Adoption Support Program Limitation English (Word)
English (PDF)
09-126 Local Indian Child Welfare Advisory Committee Confidentiality Agreement English (Word)
English (PDF)
09-127 Rights of Children and Youth in Foster Care English (Word)
English (PDF)
09-128 Child Fatality Case Review Confidentiality Agreement English (Word)
English (PDF)
09-129 Child Near Fatality Case Review Confidentiality Agreement English (Word)
English (PDF)
09-131 Background Check Request/Decision English (Word)
English (PDF)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
09-132 Employee Background Check Request/Decision English (Word)
English (PDF)
09-133 Group Care Background Check Request/Decision Form

10-2023

English (Word)
English (PDF)
09-134 Relative Inquiry English (PDF) Download and save to desktop before filling in form.
Marshallese (PDF)
Trukese (PDF)
09-154 NCIC Purpose Code C Background Check Summary English (Word)
English (PDF)
09-160 Background Check Hearing Request Form English (Word)
English (PDF)
09-162 Background Check Reconsideration Request English (Word)
English (PDF)
09-164 Request for Early Learning Background Check Results

03-2024

English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
09-165 Portable Background Check Application

03-2024

English (PDF)
09-539 Inquiry to Indian Tribe English (Word)
English (PDF)
09-611 Release and Consent for Child Specific Recruitment English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
09-653 Background Check Authorization English (Word)
English (PDF)
Amharic (PDF)
Cambodian (PDF)
Chinese (PDF)
Chinese (PDF)
Korean (PDF)
Laotian (PDF)
Maay Maay (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)
09-761 Indian Identity Request English (Word)
English (PDF)
09-765 Declaration of Adoption Facilitator - Indian Child

04-2023

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
09-837 Disclosure of Confidential HIV / AIDS Information English (Word)
English (PDF)
09-966 Authorization to Release Information to the Court English (Word)
English (PDF)
09-997 Adoption Support Worksheet English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
09-998 Application for the Adoption Support Program and/or Reimbursement of Adoption Finalization Costs English (Word)
English (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
10-016 File Checklist and Certification for License of Foster Home

03-2024

English (Word)
10-035 Receiving Care Transition Summary

12-2023

English (Word)
10-036 Emergency Placement Services (EPS) Transition Summary

01-2024

English (Word)
10-042 Child Protective Services Casework Checklist English (Word)
English (PDF)
10-043 Home Study

12-2023

English (Word)
Amharic (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tigrigna (PDF)
Vietnamese (PDF)
10-045 Policies and Procedures for Child Placing Agency (CPA) Foster Care
10-045A Policies and Procedures for Child Placing Agency (CPA) Adoption Only
10-045B Policies and Procedures for Group Care
10-046 Budget for Child Placing Agency (CPA)
10-046B Budget for Group Care
10-055 Group Receiving Center Checklist
10-056 Initial/Kinship License Request for Tribes

03-2024

English (Word)
10-061 Child’s Registration English (Word)
English (PDF)
10-082 Adoption Support Modification Worksheet

01-2024

English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
10-083 Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment English (Word)
English (PDF)
10-114 Adoption Data Card English (Word)
English (PDF)
10-166A Behavioral Rehabilitation (BRS) Referral English (Word)
English (PDF)
10-182 File Checklist (Foster License) English (Word)
10-182A File Checklist (Unlicensed) English (Word)
Spanish (Word)
Spanish (PDF)
10-182B File Checklist (Provisional Expedited License) English (Word)
10-182C File Checklist (Kinship License) English (Word)
10-183 Home Inspection Checklist (Licensed) English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
10-214 Pre-Authorization For Services English (Word)
English (PDF)
10-248 Compliance Agreement

11-2022

English (Word)
Spanish (PDF)
Spanish (Word)
10-248B Compliance Agreement for Child Placing Agency (CPA)

11-2023

English (Word)
10-248C Compliance Agreement for Group Care

11-2023

English (Word)
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)
10-354 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)
10-395 Intensive Family Service Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary English (Word)
English (PDF)
10-405 Foster Home Reassessment English (Word)
10-405B Foster Home Move Reassessment English (Word)
10-408 Application for Child Care Agency License or Certification English (Word)
English (PDF)
10-416 Foster Home Monitoring Visit English (Word)
Spanish (PDF)
Spanish (Word)
10-419 Supervision Plan for Site Specific Conditions

11-2022

English (Word)
Spanish (PDF)
Soninke (PDF)
10-425 Reference Questionnaire (Certified Respite) English (Word)
Spanish (Word)
Spanish (PDF)
10-428 Caregiver Support Plan English (Word)
English (PDF)
10-432 Extended Foster Care Program Participation Agreement English (Word)
English (PDF)
French (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
10-453 Home Inspection Checklist (Kinship) English (Word)
Spanish (Word)
Spanish (PDF)
10-454 DCYF Caregiver Authorization English (PDF)
Laotian (PDF)
Mam (fillable PDF)
Spanish (fillable PDF)
10-455 Medication Log

02-2024

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
10-459 Courtesy Supervision Referral English (Word)
English (PDF)
10-462 User Application and Acknowledgement English (Word)
English (PDF)
10-463 FamLink Data Access Request / Change English (Word)
English (PDF)
10-464 FamLink Access Application and Acknowledgement English (Word)
English (PDF)
10-474 FAR Family Assessment English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Cambodian (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Vietnamese (PDF)
10-475 Early Invention Program (EIP) Exit Summary English (Word)
English (PDF)
10-477 Adoption Support Program Application Checklist English (Word)
English (PDF)
10-479 Early Intervention Program (EIP) 90 Day Review English (Word)
English (PDF)
10-479 Early Intervention Program (EIP) 90 Day Review English (Word)
English (PDF)
10-480 Comprehensive Family Evaluation English (Word)
English (PDF)
10-484 Youth Run Prevention Plan English (Word)
English (PDF)
10-490 Child Specific Contract or Extra Supervision Rate Proposal English Excel
10-500 Acknowledgement of Child’s Adoptive File Provided to Adoptive Family: English (Word)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)
10-537 Interstate Compact for the Placement of Children (ICPC) Parent Home Study Information 10-537
10-537
Spanish (PDF)
Spanish (Word)
10-539 Interstate Compact for the Placement of Children (ICPC) Reference Questionnaire for Parent Home Study English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
10-540 Project SafeCare Monthly Summary English (Word)
English (PDF)
10-545 Family Feedback Questionnaire English (Word)
English (PDF)
10-546 Adoption Archive Request for Non-Identifying Information English (Word)
English (PDF)
10-566 Contracted Health and Safety Visit Referral English (Word)
English (PDF)
10-567 Contracted Health and Safety Visit Report English (Word)
English (PDF)
10-586 Preauthorization for In-Home Services English (Word)
Spanish (Word)
Spanish (PDF)
10-606 Adoptive Parent Counseling Preauthorization for Services English (Word)
English (PDF)
10-650 ESIT Authorization for Release of Records English (PDF)
Amharic (PDF)
Arabic (PDF)
Chinese (PDF)
Farsi (PDF)
Khmer (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (PDF)
11-011 2022 Spring HVSA Expansion Funding Opportunity Letter of Intent to Apply English (Word)
11-011A HVSA Tribal Home Visiting Funding Opportunity Letter of Intent English (Word)
11-014 Family Resource Center Capacity Building Funding Opportunity English (Word)
11-015 CBCAP Returning Programs

04-2024

English (Word)
11-016 Perinatal Mental Health Year-End Community Report Template English (Word)
11-017 Diaper Bank Partnership Quarterly Report Form English (Word)
11-018 Perinatal Mental Health Returning Program

04-2024

English (Word)
11-019 Diaper Bank Concrete Good for Families Quarterly Report Form English (Word)
11-020 Tribal Fatherhood Support Program Funding Opportunity English (Word)
11-021 HV-BAT Supplemental Form English (Word)
11-022 Family Resource Center Capacity Building Work Plan English (Word)
11-023 FRC Quarterly Report Form

02-2024

English (Word)
11-024 Tribal Fatherhood Supports Project Plan English (Word)
11-025 Option 1A English (Excel)
11-026 Option 1B English (Excel)
11-027 Option 2 English (Excel)
11-028 Tribal Fatherhood Quarterly Reports

02-2024

English (Word)
11-029 Quarterly Reporting Tool - Stengthen Families Locally English (Excel)
11-030 Youth and Young Adult Housing Response Team Referral English (Word)
11-031 Strengthen Families Locally Priority Project Proposal English (Word)
11-032 Strengthen Families Locally (SFL) Budget Templatae English (Excel)
12-001 Special Needs Child Care Rate Request English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Dari (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Lingala (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tigrigna (PDF)
Ukranian (PDF)
Urdu (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)
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)
13-001B Applicant Mental Health Report English (Word)
Spanish (PDF)
13-041 Family Genetic and Medical History English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
13-200 Health & Safety Checklist English (Word)
13-904 Diabetes Care and Action Plan English (Word)
English (PDF)
13-907 Brief Assessment of Anxiety and PTSD: Caregiver/Parent English (Word)
English (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
13-908 Brief Assessment of Anxiety and PTSD: Child / Youth (SCARED)

01-2024

14-001 Employment Verification for State Training

07-2021

English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
14-002 Trainer Observation Rubric English (Word)
English (PDF)
14-003 Trainer Observation Rubric (Self Paced) English (Word)
14-005 OJJDP Title II Pass Through Fund English (Word)
14-011 Enrollment Application Medical and Dental Benefits English (PDF) If using chrome, save form to desktop before filling in form
Somali (PDF)
Spanish (PDF)
14-011a Change Form Medical and Dental Benefits English (PDF)
Spanish (fillable PDF)
Somali (fillable PDF)
14-012 Consent for Release of Information

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)
14-025 Early Achievers Extension Application English (Word)
Somali (Word)
Spanish (Word)
14-040 Non ECEAP Child Request for ECLIPSE Enrollment

02/2024

English (Word)
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)
14-252 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)
14-255 Early Childhood Equity Grant Application

02-2024

English (Word)
14-281 Source of Funds Application for Child in Placement English (Word)
English (PDF)
14-293 Title IV-E Initial Eligibility Determination Income Calculation Worksheet English (Word)
English (PDF)
14-319 IV-E Eligibility Determination for an Adoption Support Application English (Word)
English (PDF)
14-319A IV-E Eligibility Determination for Federal Funds for GAP, Guardianship Assistance Program English (Word)
English (PDF)
14-417 CCSP Application English (Word)
Albanian (PDF)
Amharic (PDF)
Chinese (PDF)
Dari (PDF)
French (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)
14-430 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)
14-434 Title IV-E Requirements for Out of State Foster Care Payments English (Word)
English (PDF)
14-435 Provider Employment Eligibility Verification English (Word)
English (PDF)
14-438 Stop Work English (Word)
Amharic (PDF)
Arabic (PDF)
Chinese (PDF)
Dari (PDF)
Oromo (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
Vietnamese (PDF)
14-444 Child Health and Education Tracking Screening Report

09-2023

English (Word)
Spanish (Word)
Spanish (PDF)
14-446 Declaration of Financial Status for Adoption Support Application English (Word)
English (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)
14-474 Shared Planning Meeting English (Word)
Spanish (Word)
Spanish (PDF)
Cambodian (PDF)
Chinese (PDF)
Korean (PDF)
Mandinka (PDF)
Russian (PDF)
Somali (PDF)
Swahili (PDF)
Thai (PDF)
Tigrinya (PDF)
Trukese (PDF)
Vietnamese (PDF)
14-510 Certified Respite Provider Agreements English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
14-512 Application for Certified Respite Provider English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
14-531 Education and Training Voucher (ETV) Program and Passport to Careers Program 2024 – 2025 Application

08-2023

English (Word)
14-531A Education and Training Voucher (ETV) Program and Passport to Careers Program Application Consent English (Word)
English (PDF)
14-545 Extended Adoption Support Application English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
14-548 Independent (IL) / Transitional Living (TL) Grant Application English (Word)
English (PDF)
14-600 Interim Individualized Family Service Plans (IFSP) (ESIT) English (Word)
15-005 ESIT Health Care Referral Form English (Word)
English (PDF)
15-015 Child Care Subsidy Program Site Change Form English (Word)
English (PDF)
15-016 HVSA Local Implementing Agency Contact Update Form English (Word)
English (PDF)
15-027 Professional Services Referral English (Word)
English (PDF)
15-028 Psychological Services Referral English (Word)
English (PDF)
15-029 Psychiatric Services Referral English (Word)
English (PDF)
15-030 Substance Use Disorder Professional (SUDP) Referral

04-2024

English (Word)
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)
15-051 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 English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Laotian (PDF)
Marshallese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Urdu (PDF)
Vietnamese (PDF)
15-054 Notice and Consent for Evaluation/Assessment English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
15-055 Individualized Family Service Plan (IFSP) English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Telugu (PDF)
Tamil (PDF)
Ukranina (PDF)
Urdu (PDF)
Vietnamese (PDF)
15-056 Notice of Consent for Initial Evaluation Assessment English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Laotian (PDF)
Mashallese (PDF)
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)
15-058 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)
15-059 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
15-060 Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report English (Word)
15-092 The Interstate Compact on the Placement of Children (ICPC) Placement Request English (Word)
English (PDF)
15-093 Interstate Compact on the Placement of Children (ICPC) Report on Child’s Placement Date or Change of Placement – 100B English (Word)
English (PDF)
15-209A Health/Mental Health and Education Summary English (Word)
English (PDF)
15-209C Visit Plan English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tagalog (PDF)
Tigrigna (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
15-245 LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
15-258 Safety Assessment / Safety Plan Combined

05-2023

English (Word)
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 English (Word)
English (PDF)
Chinese (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
15-260 Parents Information Sheet for Shared Planning Meetings and Staffings English (Word)
English (PDF)
15-266 Child Protect Teams (CPT) Staffing Recommendations English (Word)
English (PDF)
15-267 Attendance and Confidentiality Agreement English (Word)
English (PDF)
Vietnamese (PDF)
15-268 Child Protect Teams (CPT) Case Presentation Summary English (Word)
English (PDF)
15-276 Personal Information English (WORD)
Marshallese (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tagalog (PDF)
Tigrigna (PDF)
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)
Russian (PDF)
Somali (PDF)
Soninke (PDF)
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)
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)
15-322 Long Term Care Agreement for Foster Parents or Relative Caregivers English (Word)
English (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
15-324 Guardianship Approval Checklist English (Word)
Spanish (Word)
Spanish (PDF)
15-349a Kinship Respite Overcapacity WAC 110-148-1390 English (Word)
15-359 Child's Physical Description English (Word)
English (PDF)
15-362 Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home English (Word)
English (PDF)
15-363B Provider Notification of Visit/Transport Schedule Initial Intake Screening Report English (Word)
English (PDF)
15-363C Visit Coordination Plan English (Word)
English (PDF)
15-368 Education and Training Voucher (ETV) Program Participation Agreement English (Word)
English (PDF)
15-368A Education and Training Voucher (ETV) Program Dual Credit Participation Agreement English (PDF)
English (Word)
15-369 Education and Training Voucher (ETV) Program 2024 - 2025 Renewal Application

08-2023

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 English (Word)
15-386 Independent Living Learning Plan and Progress Report - IL Provider

02-2024

English (Word)
15-402 Notice to Foreign Consulate of Child Protection Proceedings English (Word)
English (PDF)
15-411A Licensing Waiver (Foster Home) English (Word)
15-411D Administrative Approval (Foster Home) English (Word)
15-411G Kinship License Non-Safety Exemption/Waiver (Licensed Home) 15-411G.docx
15-412 Request for Extension and Disability Verification for Youth Over Age 18 English (Word)
English (PDF)
15-416 Interstate Compact for Adoption Medical Assstance ICAMA English (Word)
15-417 Transition Plan for Youth Exiting Care English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
15-425 Adoption Redaction Request English (Word)
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) English (Word)
English (PDF)
Dari (PDF)
French (PDF)
Spanish (PDF)
Spanish (Word)
15-434 On-Going Mental Health (OMH) Screening Report English (Word)
Spanish (Word)
Spanish (PDF)
15-448 Family Time Report English (Word)
Spanish (Word)
Spanish (PDF)
15-448A Supported Visit Report English (Word)
English (PDF)
15-450 Child Specific Caregiver Notification English (Word)
English (PDF)
15-451 Missed and No Show Report: Parent – Child Visit English (Word)
English (PDF)
15-452 Sibling Visit Report English (Word)
English (PDF)
15-454 Unusual Incident Report English (Word)
15-455 Vaccine Exemption English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
15-460 Background Confirmation and Out of State Check

03-2024

English (Word)
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)
15-720 Interest Survey for Organization License Pilot English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
15-820 Tuberculosis (TB) Screening LD

06-2023

English (Word)
English (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
15-821 Infant Safety Agreement English (Word)
Marshellese (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Vietnamese (PDF)
15-821a Infant Safety Certified Respite English (Word)
Spanish (Word)
Spanish (PDF)
15-822 Influenza Vaccination Agreement

09-2022

English (Word)
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 English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
15-824 Authorization and Consent to Share Records English (Word)
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)
15-841 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)
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) 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)
15-891 Chimney, Fireplace, Woodstove Use Statement English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
15-892 Fire, Safety, Emergency Drills Record English (Word)
Somali (PDF)
Spanish (PDF)
15-893 Multiple Licenses Request Form English (Word)
15-894 Family Home Child Care Liability Insurance Form Engllish (Word)
English (PDF)
Somali (PDF)
Spanish PDF)
15-895 Overnight Child Care Planning Guide English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
15-896 Probation Notification Letter to Parents from Provider English (Word)
15-897 Child Care Parent Guardian Permissions English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
15-899 Child Licensee or Assistant Resume English (Word)
English PDF)
Somali (PDF)
15-937 Child Care Center School-Age Background Checklist

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 English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
15-969 Child Care Medication Log Englislh (Word)
Somali (PDF)
Spanish (PDF)
15-970 Individual Care Plan for Child in Child Care English (Word)
English (PDF)
Spanish (PDF)
15-974 Declaration of Compliance

12-2023

English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
15-980 School Age License Application

01-2024

English (Word)
English (PDF)
16-005 Electronice Attendance Provider Welcome Letter (Barcode) English (Word)
English (PDF)
16-010 Parental Advisory Group (PAG) Cover Letter and Application English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
Spanish (Word)
16-015 State Approved Training Concern Form English (Word)
English (PDF)
16-025 Contractor Certification English (Word)
16-030 Book Review Worksheet for Foster Parent Training Hours English (Word)
Spanish (Word)
Spanish (PDF)
16-179 Reference Questionnaire Request English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
16-183 Emergency Respite Center Checklist

01-2019

English (Word)
16-184 Maternity Services Checklist

01-2019

English (Word)
16-186 Crisis & Secured Crisis Residential Checklist

01-2019

English (Word)
16-188 Medically Fragile and Children with Intellectual and Developmental Disabilities Checklist

01-2019

English (Word)
16-189 Group Home Checklist

01-2019

English (Word)
16-190 Overnight Youth Shelter Checklist

01-2019

English (Word)
16-204 Emergency and Evacuation Plan

01-2023

English (Word)
Marshallese (PDF)
Samoan (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
16-209 Archived Records Memo Adoption and/or Legally Free Children Aged Out English (Word)
English (PDF)
16-217 Washington State ICPC Quarterly Supervision Report English (Word)
English (PDF)
16-225 File Checklist (Certified Respite) English (Word)
Spanish (Word)
Spanish (PDF)
16-235 Photo, Video or Audio Release Waiver English (PDF)
Chinese (PDF)
Somali (PDF)
Spanish (PDF)
17-041A Request for DCYF Records

02-2024

English (Word)
English (PDF)
17-063 Written Authorization English (Word)
English (PDF)
Amharic (PDF)
Vietnamese (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)
17-215 DCYF Checklist: Subcontractor Approval Request English (Word)
English (PDF)
17-215A DCYF Checklist: Subcontractor Approval Request English (Word)
English (PDF)
17-251 FERPA Access Request English (Word)
English (PDF)
18-400 Foster Caregiver Reimbursement Claim English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
18-400A Foster Caregiver Third Party Liability Claim English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
19-015 Workforce Retention Grant Verification Form English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
20-015 Juvenile Rehabilitation Youth Engagement Request English (Word)
20-016 JR Marriage Approval for Release of Information English (Word)
English (PDF)
20-017 JR Marriage Application English (Word)
English (PDF)
20-020 Acknowledgement of JR Policy 6.70 Marriage in JR Facilities English (Word)
English (PDF)
20-270 Juvenile Justice System Improvement Technical Assistance Grant Application English (Word)
23-005 Three Pronged Approach (TPA) I. Parent Interview Questions Related to Vision and Hearing English (Word)
Spanish (fillable PDF)
23-006 Three-Pronged Approach (TPA) Developmental Skills Checklist Related to Vision and Hearing in Young Children English (PDF)
Spanish (fillable PDF)
23-007 Three-Pronged Approach (TPA) Summary Form Addressing Vision and Hearing Concerns English (PDF)
Amharic (fillable PDF)
Arabic (fillable PDF)
Bengali (fillable PDF)
Cambodian (fillable PDF)
Chinese (fillable PDF)
Chinese Traditional (fillable PDF)
Dari (fillable PDF)
Farsi (fillable PDF)
French (fillable PDF)
Hindi (fillable PDF)
Japanese (fillable PDF)
Nepali (fillable PDF)
Pashtu (fillable PDF)
Portuguese (fillable PDF)
Punjabi (fillable PDF)
Russian (fillable PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
Tagalog (fillable PDF)
Telugu (fillable PDF)
Tamil (fillable PDF)
Tigrigna (fillablePDF)
Vietnamese (fillable PDF)
23-032 In-State Child Abuse and Neglect Founded Findings Request English (Word)
English (PDF)
23-033 Child Abuse and Neglect Information Request English (Word)
English (PDF)
23-035 CHINS/ARY Report to Juvenile Court English (Word)
English (PDF)
23-036 Child Placing Agency Foster Home Licensing Investigation English (Word)
23-037 Background Clearance Notification English (Word)
23-041 Washington State Child Abuse and Neglect Founded Findings Request from Another State English (Word)
English (PDF)
23-046 ECEAP Program Monitoring Community Partner Questionnaire English (Word)
English (PDF)
27-164 Single Parent Declaration

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)