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Indiana Department of Child Services

DCS  > Forms > Foster/Relative Licensing and Placement Forms Foster/Relative Licensing and Placement Forms

 

Licensing

(Forms are fillable unless noted.)

Alternative Training Verification 52643/CW 2110

Annual Report Regarding Resource Family Home  SF53213

Annual Review Checklist for Foster Family Homes  SF 53154

Application for Criminal History Background Check 53259/CW 3610 

Application for Foster Family Home License 10100/CW 0317  
Documents pertinent information about those seeking to provide foster care to children in the care of the state.

Application for Foster Family Home License: Notice of Automatic System Withdrawal  SF 53140
Read Only

Child Behavioral/Health Challenges  SF53199

Child Care Plan  SF54608

Consent to Release of Mental Health and Addiction Records  SF 51128

Corrective Action Plan  SF 53171

Foster/Adoptive Family Inventory SF 54607

Indiana Request for a Child Protection Service (CPS) History Check SF 52802

Indiana Request for a Child Protection Service (CPS) History Check SF 52802 Instructions

Initial Inquiry Regarding Foster Family Home Licensure  SF  53204

Initial Licensure Checklist for Foster Family Homes SF 53153

In-Service Training Log  SF 54611

Licensing Staff Inquiry Regarding Foster Family Home SF 53214

Medical Report for Household Members SF 45144

Medical Report for Caregivers SF 45145

Pre-Service/In-Service Evaluation of Trainee  SF 52760

Pre-Service/In-Service Evaluation of Training  SF  52759

Record Of Training 46455/CW 0001

Relicensure Checklist for Foster Family Homes SF  53155

Request for Personal Reference Statement for Foster Family Home License Applicants  SF 53203

Residential Pool Requirements/Body of Water Safety Plan  SF  54609

Resource Family Home Physical Environmental Checklist SF 53186

Resource Family Preparation Assessment

Resource Family Preparation Assessment Cover/Signature Page SF 52795

Resource Home License Transfer  SF 54781

Resource Parent Role Acknowledgment SF 54642 [Read-only]

Voluntary Withdrawal of Application for Licensure or Relinquishment of Foster Family Home License
SF 53237/CW 3340 

Water Agreement SF 54612

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Placement

Child Placing Agency (CPA) and Department Managed Foster Homes Request for Review of Childs Category of Supervision, SF 55158   PDF  Word

Follow-Up Action for Name-Based Check, 53424 

Foster Parent Travel Invoice SF 54836

Foster Parent Travel Invoice Instructions (effective 3/1/13)

Record of Child Placement SF 54610

Relative Parent Travel Invoice Instructions

Relative Parent Travel Invoice (Excel) SF 54981

Standard Invoice - Claim for Support of Children Payable from Family & Children Funds (Excel) 28808/DCS 0327

Automated Direct Deposit Authorization Agreement SF47551

W-9 Request for Taxpayer Identification Number and Certification

  • W-9 and Direct Deposit Form Instructions 
  • W-9 and Direct Deposit Form Q&A 

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