PDF
Word
This version of the form is not currently in use and is provided for reference only. Download this version of
DSHS Form 10-377
for the current year.
DSHS Form 10-377 Notification of Age Four (4) Eligibility Expiration - Washington
What Is DSHS Form 10-377?
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 10-377?A: DSHS Form 10-377 is the Notification of Age Four (4) Eligibility Expiration form.
Q: What is the purpose of DSHS Form 10-377?A: The purpose of DSHS Form 10-377 is to notify parents or guardians of a child's eligibility expiration for certain services at the age of four.
Q: Who is required to complete DSHS Form 10-377?A: Parents or guardians of a child who is turning four years old and has been receiving services covered by the form.
Form Details:
- Released on October 1, 2019;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Available in Tagalog;
- Quick to customize;
- Compatible with most PDF-viewing applications;
- Fill out the form in our online filing application.
Download a printable version of DSHS Form 10-377 by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
Download DSHS Form 10-377 Notification of Age Four (4) Eligibility Expiration - Washington
1
2
