Date Placed: Previous Placement Name Address: Address: From: To: Current Placement Name: Address: Address: From: Medicaid Card Mailing Address (if different
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5460.pdf
KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing 500 SW Van Buren Street 2 nd Floor
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Physical Address of Home (Street Address
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Mailing Address if different from Above
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 662 Relative and Non-related Kinship Renewal Application.pdf
Physical Address of Facility (Street Address
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Mailing Address if different than above
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license: License Number: Dates of Operation: Address on the previous/current license: Page 2
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 051 Application Facilities.pdf
Provide DOB, race, gender and address for all person’s age 10 and older NOSF (Notice of
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Physical Address of Home (Street Address
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Mailing Address of home (if different from above
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 661 Relative and Non-Related Kinship Application 7.24 update.pdf
FCL 005 Rev. 09/25 KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing 500 SW Van Buren Street 2 nd Floor Topeka, Kansas 66603 Website: http://www.dcf.ks.gov
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Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 005 Yearly Mechanical Safety Check.pdf
FCL 402 Rev. 09/25 KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing 500 SW Van Buren
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Physical Address of Home (Street Address
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Mailing Address if different from Above
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 402 FFH Renewal Application.pdf
FCL 656 Rev. 09/25 KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing 500 SW Van Buren Street 2 nd Floor Topeka, Kansas 66603 Website
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Email Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 656 CPA Withdrawal of Sponsorship.pdf
FCL 004 Rev. 09/25 Kansas Department for Children and Families Foster Care Licensing and Background Checks Division
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Physical Address of the Family Foster Home City Zip Code County
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 004 NOSF for Sponsoring Agency Fillable.pdf
Provide DOB, race, gender and address for all person’s age 10 and up
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Call, text, or chat with the
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Physical Address of Home (Street Address
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Mailing Address of home (if different from above
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 401 Family Foster Home Application.pdf
KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES Foster Care Licensing 500 SW Van Buren Street 2 nd Floor Topeka, Kansas 66603 Website: http://www.dcf.ks.gov REQUEST FOR TRANSFER OF
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Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 655 Request to Transfer Sponsoring Child Placement Agency.pdf