Form Rfa 01c - Resource Family Application - Confidential
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1FOR COUNTY USE ONLY
COUNTY: ________________
RESOURCE FAMILY APPLICATION-CONFIDENTIAL
VII. CHILD DESIRED (to be completed only if a child has been identified prior to approval)
I
I
•
Has a child been identified?
Check one:
Yes
No
I
I
•
Is the child currently in your home?
Check one:
Yes
No
DATE OF
GENDER
COUNTY OF
DATE OF
RELATIONSHIP
NAME OF CHILD
EDUCATION
BIRTH
JURISDICTION
PLACEMENT
TO
(GRADE, NAME &
OF CHILD
APPLICANT(S)
ADDRESS OF
SCHOOL)
PAGE 1 OF 1
Resource Family Application-Confidential
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Parent category: Legal