Form Soc 383 - Child Welfare Services Application
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1STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CHILD WELFARE SERVICES
APPLICATION
I am asking _______________________________ county welfare department for the service(s) or help with my child
or for myself. The services I want are:
I have asked for these services or help with my child or for myself because:
NAME OF CHILD
NAME OF PARENT(S)
SIGNATURE OF PARENT OR CHILD
DATE
SOC 383 (5/02)
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Parent category: Legal