Department of Children, Youth & Families

Number Sort descending	Form Name	Revision Date	File Format
15-489	Placement Entry Tool		English (Word) English (PDF)
15-491	Plan of Safe Care	03-2026	English (Word) English (PDF)
15-504	CWTAP MSW Specialist Practicum Student Caseload Title IV-E Certification	05-2026	English (PDF)
15-504A	BASW Practicum/MSW Generalist Practicum Student Title IV-E Activities Certification	05-2026	English (PDF)
15-703	Declaration of Compliance (for Outdoor Nature-Based Programs)	12-2025	English (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)	11-2025	English (Word)
15-716	Benefit-Risk Assessment and Mitigation Development for Outdoor Nature-Based (ONB) Child Care Programs		English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
15-820	Tuberculosis (TB) Screening LD	06-2026	English (PDF)
15-820A	Tuberculosis (TB) Screening for Group Care	05-2026	English (PDF)
15-821	Infant Safety Agreement	04-2026	English (PDF) Spanish (PDF)
15-821a	Infant Safety Certified Respite	05-2026	English (PDF) Spanish (PDF)
15-822	Influenza Vaccination Agreement	05-2026	English (PDF) Spanish (PDF)
15-822a	Vaccination Agreements (Certified Respite)	05-2026	English (PDF) Spanish (fillable PDF)
15-824	Authorization and Consent to Share Records	04-2026	English (Word) Maay Maay (fillable PDF)
15-824A	Authorization and Consent to Share Records (CPA Home)	04-2026	English (PDF) Spanish (PDF)
15-824b	Authorization and Consent to Share Records (Child Placing Agency/Group Care Staff)	05-2026	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 (ONB) Child Care License Application	01-2024	English (Word) English (PDF) Somali (PDF) Spanish (Word) Spanish (PDF)
15-839	Family Home Child Care Capacity Waiver Request	04-2025	English (Word) Somali (PDF) Spanish (Word) Spanish (PDF)
15-841	ONB Initial Checklist for Applicant		English (Word)
15-845	ONB Monitoring Checklist (Example)		English (Word)
15-852	Plan to Meet Experience Qualification		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-853	Intent to Transfer License or Certification		English (Word) English (PDF) Somali (Word) Somali (fillable PDF) Spanish (Word) Spanish (fillable PDF)
15-857	Parent/Provider Health Safety Agreement (FFN)		English (Word) English (PDF) Somali (PDF) Spanish (PDF)
15-858	Emergency Contact and Permission Form (FFN)		English (Word) Somali (fillable PDF) Spanish (fillable PDF)
15-859	Safety Record and Evacuation Plan		English (Word) English (PDF) Somali (fillable PDF) Spanish (fillable PDF)