| 10-537 |
Interstate Compact for the Placement of Children (ICPC) Parent Home Study Information |
|
10-537
10-537
Spanish (PDF)
Spanish (Word)
|
|
|
| 05-320 |
2018-19 Financial Disclosure Certification |
|
English (PDF)
|
|
|
| 11-011 |
2022 Spring HVSA Expansion Funding Opportunity Letter of Intent to Apply |
|
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)
|
|
|
| 10-500 |
Acknowledgement of Child’s Adoptive File Provided to Adoptive Family: |
|
English (Word)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
| 20-020 |
Acknowledgement of JR Policy 6.70 Marriage in JR Facilities |
|
English (Word)
English (PDF)
|
|
|
| 05-305 |
ADA/504 Discrimination Complaint/Grievance Form |
|
English (PDF)
|
|
|
| 15-411D |
Administrative Approval (Foster Home) |
|
English (Word)
|
|
|
| 10-546 |
Adoption Archive Request for Non-Identifying Information |
|
English (Word)
English (PDF)
|
|
|
| 10-114 |
Adoption Data Card |
|
English (Word)
English (PDF)
|
|
|
| 15-060 |
Adoption Purchase of Services Contracted Out of State Health and Safety Visit Report |
|
English (Word)
|
|
|
| 15-425 |
Adoption Redaction Request |
|
English (Word)
English (PDF)
Spanish (Word)
Somali (PDF)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
| 10-082 |
Adoption Support Modification Worksheet |
01-2024 |
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 06-160 |
Adoption Support Monthly Counseling Billing |
|
English (Word)
English (PDF)
|
|
|
| 10-477 |
Adoption Support Program Application Checklist |
|
English (Word)
English (PDF)
|
|
|
| 09-997 |
Adoption Support Worksheet |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
| 10-606 |
Adoptive Parent Counseling Preauthorization for Services |
|
English (Word)
English (PDF)
|
|
|
| 15-286A |
Adult Child Reference Questionnaire |
|
English (Word)
English (PDF)
Arabic (PDF)
Marshallese (PDF)
Spanish (PDF)
Tagalog (PDF)
|
|
|
| 15-472 |
After-the-Fact Contract Justification |
|
English (Word)
|
|
|
| 03-374B |
Agreement on Nondisclosure of Confidential Information-Non Employee |
|
English (Word)
English (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)
|
|
|
| 14-512 |
Application for Certified Respite Provider |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
| 10-408 |
Application for Child Care Agency License or Certification |
|
English (Word)
English (PDF)
|
|
|
| 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)
|
|
|
| 09-998 |
Application for the Adoption Support Program and/or Reimbursement of Adoption Finalization Costs |
|
English (Word)
English (PDF)
Ukrainian (PDF)
Vietnamese (PDF)
|
|
|
| 05-033 |
Approval of New B-5 Subcontractos (ECEAP) 2023-2024 |
|
English (Word)
|
|
|
| 05-012 |
Approval of New Early ECEAP Site/Classroom |
|
English (Word)
|
|
|
| 16-209 |
Archived Records Memo Adoption and/or Legally Free Children Aged Out |
|
English (Word)
English (PDF)
|
|
|
| 15-267 |
Attendance and Confidentiality Agreement |
|
English (Word)
English (PDF)
Vietnamese (PDF)
|
|
|
| 15-824 |
Authorization and Consent to Share Records |
|
English (Word)
Spanish (Word)
Spanish (PDF)
Trukese (PDF)
Vietnamese (PDF)
|
|
|
| 15-824b |
Authorization and Consent to Share Records (Child Placing Agency/Group Care Staff) |
|
English (Word)
English (PDF)
|
|
|
| 15-824A |
Authorization and Consent to Share Records (CPA Home) |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 09-031 |
Authorization By Subject of Records Requested |
|
English (Word)
English (PDF)
|
|
|
| 09-966 |
Authorization to Release Information to the Court |
|
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)
|
|
|
| 09-160 |
Background Check Hearing Request Form |
|
English (Word)
English (PDF)
|
|
|
| 09-162 |
Background Check Reconsideration Request |
|
English (Word)
English (PDF)
|
|
|
| 09-131 |
Background Check Request/Decision |
|
English (Word)
English (PDF)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
| 23-037 |
Background Clearance Notification |
|
English (Word)
|
|
|
| 15-460 |
Background Confirmation and Out of State Check |
03-2024 |
English (Word)
|
|
|
| 10-166A |
Behavioral Rehabilitation (BRS) Referral |
|
English (Word)
English (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)
|
|
|
| 16-030 |
Book Review Worksheet for Foster Parent Training Hours |
|
English (Word)
Spanish (Word)
Spanish (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 |
|
|
|
| 10-046 |
Budget for Child Placing Agency (CPA) |
|
|
|
|
| 10-046B |
Budget for Group Care |
|
|
|
|
| 15-874 |
Capacity Increase Change Planning Guide |
|
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)
|
|
|
| 10-428 |
Caregiver Support Plan |
|
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)
|
|
|
| 15-259A |
Case Plan |
|
English (Word)
English (PDF)
Chinese (PDF)
Korean (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (PDF)
|
|
|
| 04-225 |
CBCAP Quarterly Report |
|
English (Word)
|
|
|
| 11-015 |
CBCAP Returning Programs |
04-2024 |
English (Word)
|
|
|
| 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)
|
|
|
| 05-250 |
Certification Regarding Environmental Tobacco Smoke |
|
English (Word)
English (PDF)
|
|
|
| 14-510 |
Certified Respite Provider Agreements |
|
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 14-011a |
Change Form Medical and Dental Benefits |
|
English (PDF)
Spanish (fillable PDF)
Somali (fillable PDF)
|
|
|
| 23-033 |
Child Abuse and Neglect Information Request |
|
English (Word)
English (PDF)
|
|
|
| 15-943 |
Child Care Agreement |
|
English (Word)
Spanish (Word)
|
|
|
| 15-708 |
Child Care Center Monitoring Checklist (Example) |
|
English (Word)
|
|
|
| 15-937 |
Child Care Center School-Age Background Checklist |
01-2024 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 07-035 |
Child Care Complex Needs Fund Verification |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 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)
|
|
|
| 15-941 |
Child Care Injury Incident Report |
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
Spanish (Word)
|
|
|
| 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)
|
|
|
| 15-897 |
Child Care Parent Guardian Permissions |
|
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
|
| 15-879 |
Child Care Registration (fh/ctr) |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 07-110 |
Child Care Stabilization Grant Application – Family, Friend, and Neighbor (FFN) License- Exempt Providers |
|
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 07-110A |
Child Care Stabilization Grant Spend Period Extension Request |
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 15-015 |
Child Care Subsidy Program Site Change Form |
|
English (Word)
English (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)
|
|
|
| 09-128 |
Child Fatality Case Review Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
| 14-444 |
Child Health and Education Tracking Screening Report |
09-2023 |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-300 |
Child Information and Placement Referral |
|
English (Word)
English (PDF)
|
|
|
| 15-899 |
Child Licensee or Assistant Resume |
|
English (Word)
English PDF)
Somali (PDF)
|
|
|
| 09-129 |
Child Near Fatality Case Review Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
| 23-036 |
Child Placing Agency Foster Home Licensing Investigation |
|
English (Word)
|
|
|
| 15-268 |
Child Protect Teams (CPT) Case Presentation Summary |
|
English (Word)
English (PDF)
|
|
|
| 15-266 |
Child Protect Teams (CPT) Staffing Recommendations |
|
English (Word)
English (PDF)
|
|
|
| 10-042 |
Child Protective Services Casework Checklist |
|
English (Word)
English (PDF)
|
|
|
| 15-450 |
Child Specific Caregiver Notification |
|
English (Word)
English (PDF)
|
|
|
| 10-490 |
Child Specific Contract or Extra Supervision Rate Proposal |
|
English Excel
|
|
|
| 09-010 |
Child Welfare History |
|
English (Word)
|
|
|
| 15-359 |
Child's Physical Description |
|
English (Word)
English (PDF)
|
|
|
| 10-061 |
Child’s Registration |
|
English (Word)
English (PDF)
|
|
|
| 15-891 |
Chimney, Fireplace, Woodstove Use Statement |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 23-035 |
CHINS/ARY Report to Juvenile Court |
|
English (Word)
English (PDF)
|
|
|
| 05-051 |
Citizen Review Panel Confidentiality Agreement |
|
English (Word)
|
|
|
| 05-050 |
Citizen Review Panel Membership Application |
|
English (Word)
|
|
|
| 07-085 |
Client Travel Approval Quick Reference Guide |
03-2024 |
English (PDF)
|
|
|
| |
Combined In-Home Contracts: Semi-Annual Quality Assurance Report |
03-2024 |
English (Word)
|
|
|
| 05-061 |
Combined In-Home Service (CIHS) Inquiry |
03-2024 |
English (Word)
|
|
|
| 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)
|
|
|
| 10-480 |
Comprehensive Family Evaluation |
|
English (Word)
English (PDF)
|
|
|
| 15-362 |
Concurrent TANF Benefits/Family Reunification Notice of Removal from TANF Home |
|
English (Word)
English (PDF)
|
|
|
| 15-050 |
Confirmation of Individualized Family Service Plan (IFSP) Schedule |
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Ukrainian (PDF)
Urdu (PDF)
Vietnamese (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)
|
|
|
| 09-111 |
Continuous Quality Improvement Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
| 15-466 |
Contract Risk Assessment / Analysis |
|
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)
|
|
|
| 16-025 |
Contractor Certification |
|
English (Word)
|
|
|
| 10-459 |
Courtesy Supervision Referral |
|
English (Word)
English (PDF)
|
|
|
| 00-002 |
COVID- 19 Prevention, Intervention and Quarantine Plan |
|
English (Word)
|
|
|
| 16-186 |
Crisis & Secured Crisis Residential Checklist |
01-2019 |
English (Word)
|
|
|
| 15-942 |
Daily Child Attendance Records |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-454 |
DCYF Caregiver Authorization |
|
English (PDF)
Laotian (PDF)
Mam (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 17-215 |
DCYF Checklist: Subcontractor Approval Request |
|
English (Word)
English (PDF)
|
|
|
| 17-215A |
DCYF Checklist: Subcontractor Approval Request |
|
English (Word)
English (PDF)
|
|
|
| 15-470 |
DCYF Regional Contract Request |
|
English (Word)
English (PDF)
|
|
|
| 09-765 |
Declaration of Adoption Facilitator - Indian Child |
04-2023 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-974 |
Declaration of Compliance |
12-2023 |
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 15-703 |
Declaration of Compliance (for Outdoor Nature-Based Programs) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 14-446 |
Declaration of Financial Status for Adoption Support Application |
|
English (Word)
English (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)
|
|
|
| 09-056 |
Dependent/Ward of the Court Verification |
|
English (Word)
English (PDF)
|
|
|
| 13-904 |
Diabetes Care and Action Plan |
|
English (Word)
English (PDF)
|
|
|
| 11-019 |
Diaper Bank Concrete Good for Families Quarterly Report Form |
|
English (Word)
|
|
|
| 11-017 |
Diaper Bank Partnership Quarterly Report Form |
|
English (Word)
|
|
|
| 09-837 |
Disclosure of Confidential HIV / AIDS Information |
|
English (Word)
English (PDF)
|
|
|
| 06-172 |
Domestic Violence Prevention Account |
|
English (Word)
English (PDF)
|
|
|
| 09-026 |
DSO & Jail Removal Data Form |
|
English (Word)
|
|
|
| 14-025 |
Early Achievers Extension Application |
|
English (Word)
Somali (Word)
Spanish (Word)
|
|
|
| 07-112a |
Early Achievers Needs-Based Grant Receipt Verification Form |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 14-255 |
Early Childhood Equity Grant Application |
02-2024 |
English (Word)
|
|
|
| 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
|
|
|
| 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)
|
|
|
| 10-475 |
Early Invention Program (EIP) Exit Summary |
|
English (Word)
English (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)
|
|
|
| 10-083 |
Early Periodic Screening, Diagnosis, and Treatment (EPSDT) Assessment |
|
English (Word)
English (PDF)
|
|
|
| 05-035 |
ECEAP & Early ECEAP Parent & Family Voices (PFV) PFV Representative ("Rep") Recruitment |
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 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
|
|
|
| 05-004 |
ECEAP Community Funded |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 05-032 |
ECEAP Complex Needs Fund Application FY 2024-25 |
|
English (Word)
|
|
|
| 05-022 |
ECEAP Contract Waiver-Variance Request to ECEAP Requirements |
|
English (Word)
|
|
|
| 05-021 |
ECEAP Contractor Alternative Attendance Plan Request |
|
English (Word)
English (PDF)
|
|
|
| 05-024 |
ECEAP Contractor Equipment Disposal Request |
|
English (Word)
English (PDF)
|
|
|
| 05-007 |
ECEAP Contractor Financial Disclosure Certification |
|
English (PDF)
|
|
|
| 05-325 |
ECEAP Porgram Monitoring Document Review Checklist |
|
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
|
|
|
| 05-009 |
ECEAP Professional Development Plan Assistant Teacher |
|
English (Word)
English (PDF)
|
|
|
| 05-010 |
ECEAP Professional Development Plan Lead Teacher |
|
English (Word)
English (PDF)
|
|
|
| 23-046 |
ECEAP Program Monitoring Community Partner Questionnaire |
|
English (Word)
English (PDF)
|
|
|
| 07-020 |
ECEAP Service Purchase Request |
|
English (Word)
English (PDF)
|
|
|
| 05-007A |
ECEAP Services Carryforward Plan |
|
English (Excel)
|
|
|
| 05-037 |
ECLIPSE Prioritization Worksheet |
04-2024 |
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
|
|
|
| 05-027 |
ECLIPSE Services Application Packet |
|
Exhibit D: Startup Budget
Exhibit E: ECLIPSE Services Application Form
Exhibit F: Certifications and Assurances
|
|
|
| 15-369 |
Education and Training Voucher (ETV) Program 2024 - 2025 Renewal Application |
08-2023 |
English (Word)
|
|
|
| 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)
|
|
|
| 15-377 |
Education and Training Voucher (ETV) Program Dual Credit Application |
|
English (Word)
|
|
|
| 15-368A |
Education and Training Voucher (ETV) Program Dual Credit Participation Agreement |
|
English (PDF)
English (Word)
|
|
|
| 15-368 |
Education and Training Voucher (ETV) Program Participation Agreement |
|
English (Word)
English (PDF)
|
|
|
| 15-370 |
Education and Training Voucher (ETV) Program Payment Request |
|
English (Word)
English (PDF)
|
|
|
| 06-179 |
Education and Training Voucher (ETV) Spending Plan |
|
English (Excel)
|
|
|
| 05-005 |
Education Appeal |
|
English (Word)
English (PDF)
|
|
|
| 06-010 |
Electronic Attendance System Vendor Approved Checklist |
|
English (Word)
English (PDF)
|
|
|
| 16-005 |
Electronice Attendance Provider Welcome Letter (Barcode) |
|
English (Word)
English (PDF)
|
|
|
| 16-204 |
Emergency and Evacuation Plan |
01-2023 |
English (Word)
Marshallese (PDF)
Samoan (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
Trukese (PDF)
|
|
|
| 15-858 |
Emergency Contact and Permission Form (FFN) |
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 10-036 |
Emergency Placement Services (EPS) Transition Summary |
01-2024 |
English (Word)
|
|
|
| 16-183 |
Emergency Respite Center Checklist |
01-2019 |
English (Word)
|
|
|
| 09-132 |
Employee Background Check Request/Decision |
|
English (Word)
English (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)
|
|
|
| 14-001 |
Employment Verification for State Training |
07-2021 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (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)
|
|
|
| 15-372 |
Enumeration Referral |
|
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)
|
|
|
| 15-005 |
ESIT Health Care Referral Form |
|
English (Word)
English (PDF)
|
|
|
| 05-060 |
Evidence Based Readiness Assessment |
08-2023 |
English (Word)
|
|
|
| 05-001 |
Expression of Interest |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 14-545 |
Extended Adoption Support Application |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 06-165 |
Extended Foster Care (EFC) Denial Letter |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-432 |
Extended Foster Care Program Participation Agreement |
|
English (Word)
English (PDF)
French (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-431 |
Extended Foster Care Program Voluntary Placement Agreement (VPA) |
|
English (Word)
English (PDF)
Dari (PDF)
French (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 03-415 |
Facility Short Term Use Application |
|
English (Word)
English (PDF)
|
|
|
| 04-220 |
Family Ancestry Chart |
|
English (Word)
English (PDF)
|
|
|
| 10-545 |
Family Feedback Questionnaire |
|
English (Word)
English (PDF)
|
|
|
| 13-041 |
Family Genetic and Medical History |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Vietnamese (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)
|
|
|
| 15-949 |
Family Home Child Care Background Checklist |
09-2023 |
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 15-894 |
Family Home Child Care Liability Insurance Form |
|
Engllish (Word)
English (PDF)
Somali (PDF)
Spanish PDF)
|
|
|
| 15-709 |
Family Home Child Care Monitoring Checklist (Example) |
|
English (Word)
|
|
|
| 11-014 |
Family Resource Center Capacity Building Funding Opportunity |
|
English (Word)
|
|
|
| 11-022 |
Family Resource Center Capacity Building Work Plan |
|
English (Word)
|
|
|
| 15-448 |
Family Time Report |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-464 |
FamLink Access Application and Acknowledgement |
|
English (Word)
English (PDF)
|
|
|
| 10-463 |
FamLink Data Access Request / Change |
|
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)
|
|
|
| 17-251 |
FERPA Access Request |
|
English (Word)
English (PDF)
|
|
|
| 15-705 |
FFN Waiver Request |
|
English (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 16-225 |
File Checklist (Certified Respite) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-182 |
File Checklist (Foster License) |
|
English (Word)
|
|
|
| 10-182C |
File Checklist (Kinship License) |
|
English (Word)
|
|
|
| |
File Checklist (Kinship License) |
|
English (Word)
|
|
|
| 10-182B |
File Checklist (Provisional Expedited License) |
|
English (Word)
|
|
|
| 10-182A |
File Checklist (Unlicensed) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-016 |
File Checklist and Certification for License of Foster Home |
03-2024 |
English (Word)
|
|
|
| 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)
|
|
|
| 15-892 |
Fire, Safety, Emergency Drills Record |
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
| 09-082 |
Five Day Notification to Move |
|
English (Word)
English (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)
|
|
|
| 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)
|
|
|
| 10-416 |
Foster Home Monitoring Visit |
|
English (Word)
Spanish (PDF)
Spanish (Word)
|
|
|
| 10-405B |
Foster Home Move Reassessment |
|
English (Word)
|
|
|
| 10-405 |
Foster Home Reassessment |
|
English (Word)
|
|
|
| 03-493 |
Foster Parent Donor Shared Leave |
|
English (Word)
English (PDF)
|
|
|
| 03-492 |
Foster Parent Recipient Shared Leave |
|
English (Word)
English (PDF)
|
|
|
| 11-023 |
FRC Quarterly Report Form |
02-2024 |
English (Word)
|
|
|
| 05-002 |
Funding Organization Commitment |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (PDF0
Spanish (Word)
|
|
|
| 09-133 |
Group Care Background Check Request/Decision Form |
10-2023 |
English (Word)
English (PDF)
|
|
|
| 16-189 |
Group Home Checklist |
01-2019 |
English (Word)
|
|
|
| 10-055 |
Group Receiving Center Checklist |
|
|
|
|
| 15-324 |
Guardianship Approval Checklist |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 02-020 |
Guide to Background Checks |
|
English (PDF)
|
|
|
| 13-200 |
Health & Safety Checklist |
|
English (Word)
|
|
|
| 15-209A |
Health/Mental Health and Education Summary |
|
English (Word)
English (PDF)
|
|
|
| 09-100 |
Hiring Education Affidavit Request (Early Learning) |
|
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)
|
|
|
| 09-101 |
Hiring Education Affidavit Request (School Age) |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-453 |
Home Inspection Checklist (Kinship) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 10-183 |
Home Inspection Checklist (Licensed) |
|
English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (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)
|
|
|
| 10-354 |
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)
|
|
|
| 11-021 |
HV-BAT Supplemental Form |
|
English (Word)
|
|
|
| 00-005 |
HVSA Expansion Application Template |
|
English (Word)
|
|
|
| 15-016 |
HVSA Local Implementing Agency Contact Update Form |
|
English (Word)
English (PDF)
|
|
|
| 11-011A |
HVSA Tribal Home Visiting Funding Opportunity Letter of Intent |
|
English (Word)
|
|
|
| 09-104 |
ICPC Closure Letter |
|
English (Word)
English (PDF)
|
|
|
| 23-032 |
In-State Child Abuse and Neglect Founded Findings Request |
|
English (Word)
English (PDF)
|
|
|
| 14-548 |
Independent (IL) / Transitional Living (TL) Grant Application |
|
English (Word)
English (PDF)
|
|
|
| 15-386 |
Independent Living Learning Plan and Progress Report - IL Provider |
02-2024 |
English (Word)
|
|
|
| 09-761 |
Indian Identity Request |
|
English (Word)
English (PDF)
|
|
|
| 15-970 |
Individual Care Plan for Child in Child Care |
|
English (Word)
English (PDF)
Spanish (PDF)
|
|
|
| 06-166 |
Individual Training Plan |
|
English (Word)
Spanish (Word)
Spanish (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)
|
|
|
| 15-821 |
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)
|
|
|
| 15-861 |
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)
|
|
|
| 10-056 |
Initial/Kinship License Request for Tribes |
03-2024 |
English (Word)
|
|
|
| 09-539 |
Inquiry to Indian Tribe |
|
English (Word)
English (PDF)
|
|
|
| 10-395 |
Intensive Family Service Preservation Service (IFPS)/Family Preservation Service (FPS) Exit Summary |
|
English (Word)
English (PDF)
|
|
|
| 15-853 |
Intent to Transfer License or Certification |
|
English (Word)
English (PDF)
Somali (Word)
Somali (fillable PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
| 15-720 |
Interest Survey for Organization License Pilot |
|
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 14-600 |
Interim Individualized Family Service Plans (IFSP) (ESIT) |
|
English (Word)
|
|
|
| 15-416 |
Interstate Compact for Adoption Medical Assstance ICAMA |
|
English (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)
|
|
|
| 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)
|
|
|
| 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)
|
|
|
| 20-017 |
JR Marriage Application |
|
English (Word)
English (PDF)
|
|
|
| 20-016 |
JR Marriage Approval for Release of Information |
|
English (Word)
English (PDF)
|
|
|
| 20-270 |
Juvenile Justice System Improvement Technical Assistance Grant Application |
|
English (Word)
|
|
|
| 20-015 |
Juvenile Rehabilitation Youth Engagement Request |
|
English (Word)
|
|
|
| 15-827 |
Kinship Caregiver iPad Equipment Checkout Agreement |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-411G |
Kinship License Non-Safety Exemption/Waiver (Licensed Home) |
|
15-411G.docx
|
|
|
| 15-349a |
Kinship Respite Overcapacity WAC 110-148-1390 |
|
English (Word)
|
|
|
| 05-041A |
Licensing Division Practice Change Request |
|
English (Word)
|
|
|
| 05-041 |
Licensing Dvisions Practice Change Request Review & Approval |
|
English (Word)
|
|
|
| 15-411A |
Licensing Waiver (Foster Home) |
|
English (Word)
|
|
|
| 15-245 |
LIMITED ENGLISH PROFICIENT (LEP)/DEAF CLIENT SERVICES LEP Client Service Record |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 09-126 |
Local Indian Child Welfare Advisory Committee Confidentiality Agreement |
|
English (Word)
English (PDF)
|
|
|
| 15-322 |
Long Term Care Agreement for Foster Parents or Relative Caregivers |
|
English (Word)
English (PDF)
Mam (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 16-184 |
Maternity Services Checklist |
01-2019 |
English (Word)
|
|
|
| 16-188 |
Medically Fragile and Children with Intellectual and Developmental Disabilities Checklist |
01-2019 |
English (Word)
|
|
|
| 10-455 |
Medication Log |
02-2024 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-860 |
Medication Permission Form For Illness and Allergies (FFN) |
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 15-451 |
Missed and No Show Report: Parent – Child Visit |
|
English (Word)
English (PDF)
|
|
|
| 15-308 |
Missing Child Staffing |
|
English (Word)
English (PDF)
|
|
|
| 15-893 |
Multiple Licenses Request Form |
|
English (Word)
|
|
|
| 09-154 |
NCIC Purpose Code C Background Check Summary |
|
English (Word)
English (PDF)
|
|
|
| 15-956 |
No Social Security Card Declaration |
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
| 14-040 |
Non ECEAP Child Request for ECLIPSE Enrollment |
02/2024 |
English (Word)
|
|
|
| 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)
|
|
|
| 15-057 |
Notice and Consent for Screening |
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
Korean (PDF)
Laotian (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telugu (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
| 15-056 |
Notice of Consent for Initial Evaluation Assessment |
|
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Laotian (PDF)
Mashallese (PDF)
Portuguese (PDF)
Punjabi (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tamil (PDF)
Telegu (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
| 15-402 |
Notice to Foreign Consulate of Child Protection Proceedings |
|
English (Word)
English (PDF)
|
|
|
| 15-954 |
Notification of Staffing Plan Absence |
|
English (Word)
Somali (PDF)
Spanish (PDF)
|
|
|
| 15-952 |
Notification to Parents and Guardian - Safe Sleep Non-Compliance |
|
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 14-005 |
OJJDP Title II Pass Through Fund |
|
English (Word)
|
|
|
| 15-434 |
On-Going Mental Health (OMH) Screening Report |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-841 |
ONB Initial Checklist for Applicant |
|
English (Word)
|
|
|
| 15-845 |
ONB Monitoring Checklist (Example) |
|
English (Word)
|
|
|
| 11-025 |
Option 1A |
|
English (Excel)
|
|
|
| 11-026 |
Option 1B |
|
English (Excel)
|
|
|
| 11-027 |
Option 2 |
|
English (Excel)
|
|
|
| 15-835 |
Outdoor Nature-Based Child Care License or Certification Application |
01-2024 |
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
|
| 15-895 |
Overnight Child Care Planning Guide |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 16-190 |
Overnight Youth Shelter Checklist |
01-2019 |
English (Word)
|
|
|
| 02-003b |
Parent Advisory Group (PAG) Application |
|
English (Word)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 05-031 |
Parent Consent to Transfer ELMS Records |
|
English (Word)
English (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)
|
|
|
| 15-857 |
Parent/Provider Health Safety Agreement (FFN) |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 16-010 |
Parental Advisory Group (PAG) Cover Letter and Application |
|
English (Word)
Somali (fillable PDF)
Spanish (fillable PDF)
Spanish (Word)
|
|
|
| 15-260 |
Parents Information Sheet for Shared Planning Meetings and Staffings |
|
English (Word)
English (PDF)
|
|
|
| 11-018 |
Perinatal Mental Health Returning Program |
04-2024 |
English (Word)
|
|
|
| 11-016 |
Perinatal Mental Health Year-End Community Report Template |
|
English (Word)
|
|
|
| 15-276 |
Personal Information |
|
English (WORD)
Marshallese (PDF)
Samoan (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Tagalog (PDF)
Tigrigna (PDF)
Trukese (PDF)
|
|
|
| 15-823 |
Pertussis Vaccination Agreement |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
Tigrigna (PDF)
|
|
|
| 15-826 |
Pet Vaccination Agreement |
06-2023 |
English (Word)
English (PDF)
Maay Maay (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
|
|
|
| 09-007 |
Petition for Review of Initial Decision (Appeal) |
|
English (Word)
English (PDF)
|
|
|
| 16-235 |
Photo, Video or Audio Release Waiver |
|
English (PDF)
Chinese (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 15-281 |
Placement Agreement |
07-2023 |
English (Word)
Arabic (PDF)
Chinese (PDF)
Russian (PDF)
Somali (PDF)
Soninke (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-489 |
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)
|
|
|
| 15-852 |
Plan to Meet Experience Qualification |
|
English (Word)
English (PDF)
Somali (PDF)
Spanish (PDF)
|
|
|
| 10-045A |
Policies and Procedures for Child Placing Agency (CPA) Adoption Only |
|
|
|
|
| 10-045 |
Policies and Procedures for Child Placing Agency (CPA) Foster Care |
|
|
|
|
| 10-045B |
Policies and Procedures for Group Care |
|
|
|
|
| 09-165 |
Portable Background Check Application |
03-2024 |
English (PDF)
|
|
|
| 10-214 |
Pre-Authorization For Services |
|
English (Word)
English (PDF)
|
|
|
| 15-469 |
Pre-Contract Action Request (P-CAR) |
|
English (Word)
English (PDF)
|
|
|
| 10-586 |
Preauthorization for In-Home Services |
|
English (Word)
Spanish (Word)
Spanish (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
|
|
|
| 15-896 |
Probation Notification Letter to Parents from Provider |
|
English (Word)
|
|
|
| 06-025 |
Professional Services Billing Statement |
|
English (Word)
English (PDF)
|
|
|
| 15-027 |
Professional Services Referral |
|
English (Word)
English (PDF)
|
|
|
| 10-540 |
Project SafeCare Monthly Summary |
|
English (Word)
English (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)
|
|
|
| 05-003 |
Provider Application Form |
|
English (Word)
English (PDF)
Somali (Word)
Somali (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| |
Provider Change Form |
|
English (PDF)
|
|
|
| |
Provider Direct Deposit Authorization Form |
|
English (PDF)
|
|
|
| 14-435 |
Provider Employment Eligibility Verification |
|
English (Word)
English (PDF)
|
|
|
| 06-097 |
Provider File Action Request |
|
English (Word)
English (PDF)
|
|
|
| 15-363B |
Provider Notification of Visit/Transport Schedule Initial Intake Screening Report |
|
English (Word)
English (PDF)
|
|
|
| |
Provider Registration Form |
|
English (PDF)
|
|
|
| 15-029 |
Psychiatric Services Referral |
|
English (Word)
English (PDF)
|
|
|
| 15-028 |
Psychological Services Referral |
|
English (Word)
English (PDF)
|
|
|
| 11-029 |
Quarterly Reporting Tool - Stengthen Families Locally |
|
English (Excel)
|
|
|
| 10-035 |
Receiving Care Transition Summary |
12-2023 |
English (Word)
|
|
|
| 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)
|
|
|
| 10-425 |
Reference Questionnaire (Certified Respite) |
|
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 16-179 |
Reference Questionnaire Request |
|
English (Word)
Marshallese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 09-134 |
Relative Inquiry |
|
English (PDF) Download and save to desktop before filling in form.
Marshallese (PDF)
Trukese (PDF)
|
|
|
| 09-611 |
Release and Consent for Child Specific Recruitment |
|
English (Word)
English (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 09-012 |
Request for Certificate of Parental Improvement (CPI) |
|
English (Word)
English (PDF)
|
|
|
| 17-041A |
Request for DCYF Records |
02-2024 |
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)
|
|
|
| 15-412 |
Request for Extension and Disability Verification for Youth Over Age 18 |
|
English (Word)
English (PDF)
|
|
|
| 08-050 |
Request/Certification of Data Destruction |
|
English (Word)
English (PDF)
|
|
|
| 15-309 |
Returning Child De-Briefing |
|
English (Word)
English (PDF)
|
|
|
| 09-127 |
Rights of Children and Youth in Foster Care |
|
English (Word)
English (PDF)
|
|
|
| 15-258A |
Safety Assessment |
|
English (Word)
|
|
|
| 15-258 |
Safety Assessment / Safety Plan Combined |
05-2023 |
English (Word)
Haitian-Creole (PDF)
Russian (PDF)
Somali (PDF)
Spanish (Word)
Trukese (PDF)
Trukese (PDF)
|
|
|
| 15-258B |
Safety Plan |
05-2023 |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-859 |
Safety Record and Evacuation Plan |
|
English (Word)
English (PDF)
Somali (fillable PDF)
Spanish (fillable PDF)
|
|
|
| 15-889 |
Sample Application for Employment or Volunteer Services Licensed or Certified Early Learning/Child Care Program |
|
English (Word)
English (PDF)
|
|
|
| 15-965 |
Sanitizer Disinfectant Approval Request |
|
English (Word)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
|
|
|
| 15-980 |
School Age License Application |
01-2024 |
English (Word)
English (PDF)
|
|
|
| 15-944 |
School Based and Military Certification for Payment Only Request |
|
English (Word)
|
|
|
| 09-093 |
School Notification |
10-2023 |
English (Word)
Spanish (Word)
Spanish (PDF)
|
|
|
| 15-707 |
School-Age Child Care Monitoring Checklist |
|
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)
|
|
|
| 15-452 |
Sibling Visit Report |
|
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)
|
|
|
| 14-281 |
Source of Funds Application for Child in Placement |
|
English (Word)
English (PDF)
|
|
|
| 12-001 |
Special Needs Child Care Rate Request |
|
English (Word)
English (PDF)
Amharic (PDF)
Arabic (PDF)
Cambodian (PDF)
Chinese (PDF)
Dari (PDF)
Farsi (PDF)
French (PDF)
Korean (PDF)
Lingala (PDF)
Pashtu (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Tigrigna (PDF)
Ukranian (PDF)
Urdu (PDF)
Vietnamese (PDF)
|
|
|
| 07-112 |
Spring 2021 Child Care COVID -19 Grant Receipt Verification |
|
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)
|
|
|
| 05-101 |
Staff Selection Criteria for Evidence Based Practices (EBP's) |
03-2024 |
English (Word)
|
|
|
| 16-015 |
State Approved Training Concern Form |
|
English (Word)
English (PDF)
|
|
|
| |
State Fiscal Quarterly Report |
|
English (Excel)
|
|
|
| 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)
|
|
|
| 02-206 |
Statement of Earnings |
|
English (Word)
English (PDF)
Albanian (PDF)
Spanish (PDF)
|
|
|
| 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)
|
|
|
| 11-032 |
Strengthen Families Locally (SFL) Budget Templatae |
|
English (Excel)
|
|
|
| 11-031 |
Strengthen Families Locally Priority Project Proposal |
|
English (Word)
|
|
|
| 15-030 |
Substance Use Disorder Professional (SUDP) Referral |
04-2024 |
English (Word)
|
|
|
| 10-419 |
Supervision Plan for Site Specific Conditions |
11-2022 |
English (Word)
Spanish (PDF)
Soninke (PDF)
|
|
|
| 15-448A |
Supported Visit Report |
|
English (Word)
English (PDF)
|
|
|
| 15-092 |
The Interstate Compact on the Placement of Children (ICPC) Placement Request |
|
English (Word)
English (PDF)
|
|
|
| 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)
|
|
|
| 14-293 |
Title IV-E Initial Eligibility Determination Income Calculation Worksheet |
|
English (Word)
English (PDF)
|
|
|
| 14-434 |
Title IV-E Requirements for Out of State Foster Care Payments |
|
English (Word)
English (PDF)
|
|
|
| 14-002 |
Trainer Observation Rubric |
|
English (Word)
English (PDF)
|
|
|
| 14-003 |
Trainer Observation Rubric (Self Paced) |
|
English (Word)
|
|
|
| 15-417 |
Transition Plan for Youth Exiting Care |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 02-006 |
Treatment Foster Care Initiative (TFCI) Referral |
|
English (Word)
Treatment Foster Care Initiative (TFCI) Information
|
|
|
| 15-945 |
Tribal Certification Request |
|
English (Word)
|
|
|
| 11-028 |
Tribal Fatherhood Quarterly Reports |
02-2024 |
English (Word)
|
|
|
| 11-020 |
Tribal Fatherhood Support Program Funding Opportunity |
|
English (Word)
|
|
|
| 11-024 |
Tribal Fatherhood Supports Project Plan |
|
English (Word)
|
|
|
| 15-820 |
Tuberculosis (TB) Screening LD |
06-2023 |
English (Word)
English (PDF)
Soninke (PDF)
Spanish (PDF)
Spanish (Word)
Trukese (PDF)
|
|
|
| 15-280 |
Unlicensed Caregiver Placement Checklist |
06-2023 |
English (Word)
English (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 02-026 |
Unsung Hero Nomination Form |
|
English (Word)
English (PDF)
Somali (Word)
Spanish (Word)
|
|
|
| 15-454 |
Unusual Incident Report |
|
English (Word)
|
|
|
| 10-462 |
User Application and Acknowledgement |
|
English (Word)
English (PDF)
|
|
|
| 15-822a |
Vaccine Agreements Certified Respite |
|
English (Word)
English (Word)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
| 15-455 |
Vaccine Exemption |
|
English (Word)
English (PDF)
Spanish (Word)
Spanish (fillable PDF)
|
|
|
| 09-013 |
Vendor Affidavit of Lost, Stolen or Destroyed Warrant |
02-2022 |
English (Word)
English (PDF)
Portuguese (PDF)
Spanish (Word)
Spanish (PDF)
|
|
|
| 05-036 |
Verification of ECEAP Eligibility |
04-2024 |
English (Word)
|
|
|
| 09-008 |
Victim/Witness Notification Program Enrollment (save to your computer before filling out) |
|
English (PDF)
|
|
|
| 15-363C |
Visit Coordination Plan |
|
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)
|
|
|
| 02-031 |
WA State Citizen Review Panels (CRP) Data Request Form |
|
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)
|
|
|
| 09-054 |
Waiver of Notice of Further Hearing |
|
English (Word)
English (PDF)
|
|
|
| 09-121 |
Waiver of Right to Receive Written Information on Adoption Support Program Limitation |
|
English (Word)
English (PDF)
|
|
|
| 23-041 |
Washington State Child Abuse and Neglect Founded Findings Request from Another State |
|
English (Word)
English (PDF)
|
|
|
| 16-217 |
Washington State ICPC Quarterly Supervision Report |
|
English (Word)
English (PDF)
|
|
|
| 19-015 |
Workforce Retention Grant Verification Form |
|
English (Word)
Spanish (Word)
Spanish (PDF)
Somali (PDF)
|
|
|
| 17-063 |
Written Authorization |
|
English (Word)
English (PDF)
Amharic (PDF)
Vietnamese (PDF)
Russian (PDF)
Somali (PDF)
Spanish (PDF)
Spanish (Word)
Vietnamese (PDF)
|
|
|
| 11-030 |
Youth and Young Adult Housing Response Team Referral |
|
English (Word)
|
|
|
| 10-484 |
Youth Run Prevention Plan |
|
English (Word)
English (PDF)
|
|
|
