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Foster/Relative Licensing and Placement Forms



(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

Financial Verification for Foster Family Homes  SF 55734

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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Indiana Relative/Kinship/Foster Placement Court Reporting Form (Save PDF to your computer for fillable version.)

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

Resource Parent Complaint Resolution Form

Follow-Up Action for Name-Based Check, 53424

Foster Parent Travel Invoice SF 54836

Foster Parent Travel Invoice Instructions

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

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