Family Finding - Caseworker Referral Q & A
County:
Referral Date:
Case Number:
Case Name:
Child/Children's Names:
Child/Children's
Birth-Month-and-Year or Ages
Case Worker Name:
Case Worker E-Mail:
Case Worker Phone:
Case Worker Supervisor
[optional]
:
What is the current permanency plan for the child?
Reunification
Guardianship
ILP
Relative Care
Adoption
APPLA
Is there a permanent resource for the youth? If yes, who?
Yes
No
Who?
Ethnic Background of the Child or Children
Asian
Bi-Racial (Black & White)
Black / African American
Hispanic / Latino
Mixed (2 or more races, not black & white)
American Indian / Alaska Native
Pacific Islander / Hawaiian
Unknown
White / Caucasian
[ALL OF THE FOLLOWING ARE VERY HELPFUL, BUT OPTIONAL]
Do You need Family Finding Reports For A Future Court Date?
If so, when is it?
Yes
No
When?
What would be your goal for this case now that it has been referred to Family Finding?
Legal Father (is there one recognized?)
Mother's Last Contact?
Relatives or connections that are currently involved?
Stability of current placement?
Safety concerns around this case?
Length of Time in Care
Number of Times the Child Has Moved, While in Care (if Known)
Others working on this case with the youth?
CASA
Name:
Phone:
Email:
Mentor
Name:
Phone:
Email:
Attorney
Name:
Phone:
Email:
Foster Parent
Name:
Phone:
Email:
Other
Name:
Phone:
Email:
Other Relatives Known to the Agency
Relationship:
Name:
Phone:
Email:
Relationship:
Name:
Phone:
Email:
Relationship:
Name:
Phone:
Email:
Relationship:
Name:
Phone:
Email:
Relationship:
Name:
Phone:
Email: