Complete this form or go on-line at www.dcf.ks.gov to apply
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Daytime Phone: Message Phone: Home Address: City: Zip: Mailing Address (if different): City: Zip: Suspicion-based drug
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3100_9_grandparents_as_caregivers_application07-17.pdfView duplicates
SECTION I: Note: This is a Change of Venue This was an open Family Preservation case
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Email address
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If ICWA applies, has tribe been
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Mother’s address
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Father’s address
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E-Mail Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5110.pdf
KANSAS LAWS AND REGULATIONS FOR LICENSING PRIVATE CHILD PLACING AGENCIES Department for Children and Families March 2022 Foster Care Licensing Division 555 SW
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/Child Placement Agency Laws and Regulation Book 2022.pdfView duplicates
List of suggested bidders, including name, address and e-mail address if available
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weaknesses of each proposal with an attempt to address items including (but not limited to
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https://www.dcf.ks.gov/Agency/Testimony/Documents/2017/2017 Session DCF Testimony to House Federal and State Affairs on HB 2201.pdf
KANSAS DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES
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Please address referrals or questions to the appropriate staff below
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72
Regulation 8 -- Change of Placement Purpose
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https://www.dcf.ks.gov/services/PPS/Documents/ICPCtrainingmanual.pdf
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
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
Preferred Name to be addressed by
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Transfer Level of Service (Change in staff responsible for the case: FC/RE/AD to aftercare
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Change of venue or tribal court jurisdiction
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Mother’s Address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3006.pdf