FCL 002 Rev 2/2019 Page 1 OF 1 KANSAS
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Initial application (new facility, move, or change of ownership
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CURRENT ADDRESS
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Street Address City State Zip
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_002_Individual_Background_Check_Request.pdfView duplicates
: When submitting an application, either an initial or renewal, do I need to have all documents
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also submit documents via fax at (785)296-8609 or by sending them to the following address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FAQ.pdf
Services FC/AD NOTIFICATION OF MOVE/PLACEMENT/CHANGE PPS 5120 REV. July 2023 Page 1 of 3
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Previous Placement Name and Address
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Change of status for sibling(s) remaining in the home
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5120 .pdf
Section I: Check the box if this is a Change of Venue case and send the PPS 5110 to both
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Enter the name, address and telephone number, pager number or cell phone number and
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5110_Instr.pdf
Notification of Grant Award (NOGA) Under Federal Grant Award (CFDA) Number 93.558 DCF Award Number EES-2021-JAG-01 THIS AGREEMENT MADE THIS DAY BETWEEN Kansas Department for
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Jobs for America's Graduates JAG NOGA SFY21.pdf
State of Kansas Adoption Exchange Child Status
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E-mail address
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Change of Venue (when that venue is moved to another contractor
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Name of new contractor: Date of change of venue
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5315.pdf
may be or has been subject to a name change at the time of adoption; the party requesting
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this Authorization with the final decree of adoption verifying a change of name, if any
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5365.pdf
Department for Children and Families Appendix 7E Prevention and Protection Services REV
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and the following steps taken to address and resolve instances of inaccurate information or
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_7E.pdf
placed in care, a report of the name, address and birthdate shall be filed with the Kansas
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(B) the name, address and telephone number of a physician to be called in case of
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FC_Regs_Laws/Gen_Regs_122-132_pg27.pdfView duplicates
State of Kansas Department for Children and Families Prevention and Protection
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Change of Placement Purpose
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(2) The identity and address or addresses of the parents or legal guardian
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_9D.pdf