KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
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Foster Care and Residential Facility Licensing Division
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Please complete the following and return to Kansas Department for
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Email Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_057_RequestForAmendment.pdf
Rev. 11/18 KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
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Foster Care Licensing and Background Checks Division PO BOX 1424 ● Topeka, KS 66601-1424 500 SW Van Buren St ● 2nd
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Email Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_411_Fingerprint-BasedCheck.pdf
https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Cornerstones of Care CPA Renewal 1 SFY24.pdf
*physical address required, including 9-digit zip code
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This grant shall remain in effect, subject to the terms and conditions stated in the original Notification of Grant
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KCCTO ITSN Renewal 1 and 2 FY22-23.pdf
**A copy of any previously approved Renewal(s) and/or Amendment(s), as well as a NEW FFATA form, NEW Debarment Memorandum and NEW Tax Clearance Certificate must be included with this
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Children's Advocacy Center of Kansas Inc. Renewal 1 and 2.pdf
Agency: Street Address* City, State, Zip* E-Mail Phone Number Fax Number Between Kansas
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Alphapointe OIB Renewal 1 and 2 SFY23.pdf
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This form must be submitted to your DCF OGG
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Agency: Street Address* City, State, Zip* E-Mail Phone Number Fax Number Between Kansas
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Resource Center for Independent Living CIL Renewal 1 and 2 SFY23.pdf
Foster Care and Residential Facility Licensing Division
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APPLICATION FOR LICENSE TO OPERATE A STAFF SECURE FACILITY
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Strong Families Make a Strong Kansas
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Email Address
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I/We plan to serve the
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_751_ApplicationUseForStaffSecureFacility.pdf
Between Kansas Department for Children and Families
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University of Kansas Medical Center Research Institute, Inc. (Project Eagle
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**A copy of any previously approved Renewal(s) and/or
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KU Project Eagle HV Renewal 1 and 2 SFY23-24.pdf
RENEWAL#: Form OGC-1010.2 REV 2/19 DCF Program may request a Renewal if they would like to
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KS 67208 Grant Year (from/to) E-Mail blippe@mhasck.org 7/1/2022 6/30/2024 Phone Number 316
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Mental Health Assoc of S.C KS Renewal 1 SFY23.pdf