Form CFS307 "Indian Child Welfare Advocacy Program Intake Form" - Illinois

What Is Form CFS307?

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

Form Details:

  • Released on June 1, 2016;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • 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 CFS307 by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS307 "Indian Child Welfare Advocacy Program Intake Form" - Illinois

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CFS 307
State of Illinois
Rev 5/2016
Department of Children and Family Services
INDIAN CHILD WELFARE ADVOCACY PROGRAM INTAKE FORM
Important directions: Please complete the form thoroughly, if information is unknown, unavailable from the reporting
family member, please note “unknown” in the field. Every field must be filled in or the form cannot be processed.
Caseworker’s Name:
Caseworker’s Telephone Number:
Caseworker’s Fax Number:
Supervisor’s Name:
Supervisor’s Telephone Number:
IDCFS Office Address:
POS Agency Name:
POS Office Address:
Region of Agency:
Indian Child Welfare Act (ICWA) Matter: X
Type of Case:
DCP
Intact
Placement
TRP
Post-TPR
Sub Guardianship
Adoption
Post-Adoption
Expedited Adoption
PERMANENCY GOAL:
Return Home Within 5 Months (21)
Guardianship (26)
Return Home Within 1 Year (22)
Independence (minor over age of 12) (27)
Return Home Pending Status Hearing (23)
Cannot be Provided For in the Home Environment (28)
Substitute Care Pending Court Decision on Termination (24)
Long Term Foster Care (29)
Adoption, if Parental Rights are Terminated/Relinquished (25)
When was the Goal Established
What is the Achievement Date
Date case open with IDCFS
Page 1 of 5
CFS 307
State of Illinois
Rev 5/2016
Department of Children and Family Services
INDIAN CHILD WELFARE ADVOCACY PROGRAM INTAKE FORM
Important directions: Please complete the form thoroughly, if information is unknown, unavailable from the reporting
family member, please note “unknown” in the field. Every field must be filled in or the form cannot be processed.
Caseworker’s Name:
Caseworker’s Telephone Number:
Caseworker’s Fax Number:
Supervisor’s Name:
Supervisor’s Telephone Number:
IDCFS Office Address:
POS Agency Name:
POS Office Address:
Region of Agency:
Indian Child Welfare Act (ICWA) Matter: X
Type of Case:
DCP
Intact
Placement
TRP
Post-TPR
Sub Guardianship
Adoption
Post-Adoption
Expedited Adoption
PERMANENCY GOAL:
Return Home Within 5 Months (21)
Guardianship (26)
Return Home Within 1 Year (22)
Independence (minor over age of 12) (27)
Return Home Pending Status Hearing (23)
Cannot be Provided For in the Home Environment (28)
Substitute Care Pending Court Decision on Termination (24)
Long Term Foster Care (29)
Adoption, if Parental Rights are Terminated/Relinquished (25)
When was the Goal Established
What is the Achievement Date
Date case open with IDCFS
Page 1 of 5
***Family Tree Begins***
CHILD(REN) NAME (List all Siblings)
DOB
ID# OR SCR#/ SACWIS #
Current Placement:
Relative
Non-Relative/Traditional Home
Residential
American/Alaskan Indian Home
Non-Indian Home
If Relative, how is Relative related to child?
Is biological mother reporting an identified tribe (if more than one tribe, list each tribe’s name)?
Yes, Tribe name/Location _____________________________________________________________
No
Unidentified (means, no identified tribe is reported; the tribal affiliation is unknown, no name)
Is biological father reporting an identified tribe (if more than one tribe, list each tribe’s name)?
Yes, Tribe name/Location _____________________________________________________________
No
Unidentified (means, no identified tribe is reported; the tribal affiliation is unknown, no name)
Biological Mother’s Information
Full Name:
Middle Name:
Maiden Name:
DOB:
SS#:
Tribal Member:
Yes
No
Unknown
Tribe Name:
Tribe Geographic Location:
Is a member enrollment card available from family member?
Yes
No
(If, yes, please send a copy along with the intake form.)
Biological Father’s Information
Full Name:
Middle Name:
DOB:
SS#:
Tribal Member:
Yes
No
Unknown
Tribe Name:
Tribe Geographic Location:
Is a member enrollment card available from family member?
Yes
No
(If, yes, please send a copy along with the intake form.)
Page 2 of 5
Biological Mother’s Parent’s Information (Maternal Grandparents to Child(ren))
Full Grandmother’s Name:
Middle Name:
Maiden Name:
DOB:
SS#:
Tribal Member
Yes
No
Unknown
Tribe Name:
Tribe Geographic Location:
Full Grandfather’s Name:
Middle Name:
DOB:
SS#:
Tribal Member
Yes
No
Unknown
Tribe Name:
Tribe Geographic Location:
If, there is further (Great, etc) or more ancestral Indian heritage provided, please list at the end of the intake form or list on a separate
paper and include with the intake form.
Please check if additional information will be attached to the form.
Biological Father’s Parent’s Information (Paternal Grandparents to Child(ren))
Full Grandmother’s Name:
Middle Name: :
Maiden Name:
DOB:
SS#:
Tribal Member
Yes
No
Unknown
Tribe Name:
Tribe Geographic Location:
Full Grandfather’s Name:
Middle Name:
DOB:
SS#:
Tribal Member
Yes
No
Unknown
Tribe Name:
Tribe Geographic Location:
If, there is further (Great, etc) or more ancestral Indian heritage provided, please list at the end of the intake form or list on a separate
paper and include with the intake form.
Please check if additional information will be attached to the form.
***Family Tree Ends***
Page 3 of 5
Additional Information and Documentation please provide, via mail, fax, email
Provide a copy of the following to the assigned ICWA Specialist:
1.
Service Plan (SP)
2.
Integrated Assessment (IA)
3.
Court Reports
Next Court Date:
Time:
Purpose:
Court Address:
Calendar:
Provide all Parties (legal) information, Name, Phone number and Email contact:
IDCFS Legal:
GAL:
Assistant State’s Attorney:
Mother’s Attorney:
Father’s Attorney:
Next Child and Family Meeting (CTFM):
Date:
Time:
Location:
Teleconference number with access code:
Next Administrative Case Review (ACR):
Date:
Time:
Location:
Teleconference number with access code:
Any upcoming staffings or meetings:
Date:
Time:
Location:
Teleconference number with access code:
Page 4 of 5
Any additional important family (tree) information:
Please email the completed intake form to the ICWA/OAA/IDCFS central intake. After receipt, an ICWA
Specialist will be assigned to your specific case.
Email:
DCFS.OfficeofAffirmativeAction@illinois.gov
Submit by Email
Mail: ICWA – Office of Affirmative Action
Print Form
1921 S Indiana, 4th floor
Chicago, IL 60616
Save Form
Fax: 1.312.328.2803
Internal OAA/ICWAP
ICWA Specialist Assigned:
Date Assigned:
Page 5 of 5
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