Form DCF-906 "Report to Superior Court for Juvenile Matters Regarding Child's Foster Home Placement" - Connecticut

What Is Form DCF-906?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on October 1, 2017;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-906 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-906 "Report to Superior Court for Juvenile Matters Regarding Child's Foster Home Placement" - Connecticut

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Connecticut Department of Children and Families
REPORT TO SUPERIOR COURT FOR JUVENILE MATTERS
REGARDING CHILD’S FOSTER HOME PLACEMENT
DCF-906
10/17 (New)
Page 1 of 2
IN RE:
SUPERIOR COURT FOR JUVENILE MATTERS AT:
DATE:
Please Select One
REPORT TO SUPERIOR COURT FOR JUVENILE MATTERS REGARDING CHILD’S FOSTER HOME PLACEMENT IN:
Foster Home
Relative Home
Fictive Kin Caregiver Home
This report is filed:
Please Select One
SUITABILITY OF FOSTER PARENTS AND HOUSEHOLD MEMBERS AGE 16 AND OVER:
Is this a Licensed foster home?:
Yes (If “Yes”, please skip to page 2 and complete the “NEEDS OF THE CHILD” section)
No If Relative or Fictive Kin Caregiver Home is NOT YET licensed, please provide the additional information below.
NOTE: due to confidentiality, DO NOT include names of potential Foster Parents or Household Members.
Relationship to Child:
Foster Parent 1
Please Select One
CPS History:
Criminal History:
Relationship to Child:
Foster Parent 2
Please Select One
CPS History:
Criminal History:
Relationship to Child:
Household Member 1
Age 16 or Older
Please Select One
CPS History:
Criminal History:
Relationship to Child:
Household Member 2
Please Select One
Age 16 or Older
CPS History:
Criminal History:
Relationship to Child:
Household Member 3
Please Select One
Age 16 or Older
CPS History:
Criminal History:
Suitability of Foster Home
If not yet licensed:
Home assessment has been conducted; physical space is safe and adequate.
Yes
No
No household members age 16 or over have CPS or criminal history.
Yes
No
Basic assessment of suitability of proposed foster parents has been conducted.
Yes
No
If answers are “No” to any of the above questions, please discuss the potential barriers to licensing:
Waiver(s) granted on:
Connecticut Department of Children and Families
REPORT TO SUPERIOR COURT FOR JUVENILE MATTERS
REGARDING CHILD’S FOSTER HOME PLACEMENT
DCF-906
10/17 (New)
Page 1 of 2
IN RE:
SUPERIOR COURT FOR JUVENILE MATTERS AT:
DATE:
Please Select One
REPORT TO SUPERIOR COURT FOR JUVENILE MATTERS REGARDING CHILD’S FOSTER HOME PLACEMENT IN:
Foster Home
Relative Home
Fictive Kin Caregiver Home
This report is filed:
Please Select One
SUITABILITY OF FOSTER PARENTS AND HOUSEHOLD MEMBERS AGE 16 AND OVER:
Is this a Licensed foster home?:
Yes (If “Yes”, please skip to page 2 and complete the “NEEDS OF THE CHILD” section)
No If Relative or Fictive Kin Caregiver Home is NOT YET licensed, please provide the additional information below.
NOTE: due to confidentiality, DO NOT include names of potential Foster Parents or Household Members.
Relationship to Child:
Foster Parent 1
Please Select One
CPS History:
Criminal History:
Relationship to Child:
Foster Parent 2
Please Select One
CPS History:
Criminal History:
Relationship to Child:
Household Member 1
Age 16 or Older
Please Select One
CPS History:
Criminal History:
Relationship to Child:
Household Member 2
Please Select One
Age 16 or Older
CPS History:
Criminal History:
Relationship to Child:
Household Member 3
Please Select One
Age 16 or Older
CPS History:
Criminal History:
Suitability of Foster Home
If not yet licensed:
Home assessment has been conducted; physical space is safe and adequate.
Yes
No
No household members age 16 or over have CPS or criminal history.
Yes
No
Basic assessment of suitability of proposed foster parents has been conducted.
Yes
No
If answers are “No” to any of the above questions, please discuss the potential barriers to licensing:
Waiver(s) granted on:
DCF-906
Page 2 of 2
NEEDS OF THE CHILD (Please keep responses brief)
Medical:
Timeline For Completion:
Dental:
Timeline For Completion:
Developmental:
Timeline For Completion:
Educational:
Timeline For Completion:
Treatment:
Timeline For Completion:
Reviewed and Approved by:
Submitted by (Name of Social Worker):
Signature of Social Worker
Date:
Approved by (Name of Social Work Supervisor):
Signature of Social Work Supervisor
Date:
Approved by (Name of Program Manager):
Signature of Program Manager
Date:
Page of 2