Get 54619.doc

Filling out the 54619.doc, a form for foster family home licensing history requests, is essential for new licensing workers involved in transfers or reinstatements. This guide provides clear and structured steps to assist users in completing the form accurately and efficiently online.

Follow the steps to complete the form online.

1. Click the ‘Get Form’ button to access the document and open it in an editable format.
2. In Section A, provide the resource identification number, the name of the foster family home applicant(s), and their address, including the city, state, and ZIP code. Also, include the agency’s name.
3. Fill in the name of the new licensing worker, their address, telephone number, fax number, and email address.
4. Move to Section B, where the previous licensing worker will provide information regarding the family’s licensing history. Indicate how long the family has been licensed with the agency and whether they will have foster children in placement at the time of transfer.
5. Note the effective date of the most recent license and, if applicable, list the county that has custody of the foster children.
6. Answer whether the family has informed the agency of their request to transfer the license and include any reasons as appropriate.
7. Document the end date of the most recent license, providing a clear explanation if the license was formally closed and the reason for closure, if applicable.
8. Indicate any corrective actions or probationary statuses the family has experienced, and describe the success in resolving any areas of concern.
9. If the family has been previously licensed by other agencies, list those agencies.
10. Use the provided performance rating scale to evaluate the applicant(s) in various areas of service. Provide explanations for any ratings marked as 'Needs Improvement.'
11. Finally, include the signature of the licensing worker, their printed name, agency name, agency address, and the date of completion.
12. Once all fields are completed, you can save your changes. Options are available to download, print, or share the completed form.

Complete the 54619.doc online to facilitate the foster family home licensing process efficiently.