Forms

  1. Annual Licensing Visit Forms
  2. Provider Forms
  3. Resident Forms
  • AFC Home Program Plan (71980-247 1/19)
    (Word) (PDF)
  • Evaluation of Agency by AFC Provider (71980-12a 11/10) (Word) (PDF)
  • Foster Home In Use (71980-19 4/12) (Word) (PDF)
  • Home Safety Checklist (DHS-16-193581 4/18) (PDF)
  • Initial/Relicensing/Alternate Year Data Sheet (71980-234 12/16)  (Word) (PDF)
  • License Applicant Privacy Rights (72000-2 7/17) (Word) (PDF)
  • Program Abuse Prevention Plan - Portrait view (71980-53 4/12) (Word) (PDF)
  • Program Abuse Prevention Plan - Landscape view (DHS-16-180922 6/15) (Word)


Additional Forms for Relicensing Visits:

  • Certificate of Compliance - Workers' Compensation (PDF)
  • Family Systems Licensing Application - AFC (DHS-16-180907 5/17) (PDF)