• Child and Family Services Plan Ute Indian Tribe

    The Ute Indian Tribe’s FY 2015-2019 Child and Family Services Plan describes how Ute Family Services (UFS) administers child welfare programs on the Uintah and Ouray Reservation, focusing on child abuse prevention, foster and kinship care, and case management with an emphasis on culturally sensitive, community-based support. The plan outlines goals such as crisis intervention, kinship care support, collaboration with tribal courts, recruitment of foster and adoptive parents, and comprehensive health care oversight. It highlights the use of data-driven progress measures, interagency coordination, regular staff training, disaster response protocols, technical assistance needs, and oversight of psychotropic medication to ensure child safety and well-being. The plan is publicly available and designed to adapt to the changing needs of Ute children and families through ongoing collaboration with tribal, state, and federal partners.

  • Family Violence Services Intake Form

    The Family Violence Services Intake Form, used by the Citizen Potawatomi Nation Family Violence Program, collects detailed information from individuals seeking help due to family violence. It gathers personal and demographic data, details about the perpetrator, the history and types of abuse experienced, safety concerns, and any legal actions taken. The form enables clients to request services such as emergency shelter, counseling, protective orders, and relocation assistance. It includes sections on confidentiality rights, consent for information sharing, and a comprehensive safety plan outlining steps for victims and their children, such as preparing emergency supplies, securing important documents, and enhancing home security. The document also offers legal guidance, workplace safety tips, and information on additional support resources, emphasizing the importance of client rights and confidentiality throughout the process.

  • Draft Intake Form Rosebud

    The “Draft Intake Form” for the Rosebud Sioux Tribe’s Defending Childhood Initiative is a detailed document designed to collect comprehensive information about children referred to the program due to exposure to violence or related issues. It gathers data on personal and family background, legal guardianship, experiences with violence, family and health history, education, substance use, legal involvement, social functioning, and cultural or spiritual practices. The form also addresses intergenerational trauma, basic needs, counseling goals, referrals, and support systems, emphasizing confidentiality and standardized information collection to support coordinated, culturally competent care and minimize retraumatization. Legal guardian and staff signatures are required to complete the intake process.

  • Child Support Services Application Delaware Tribe

    The “Child Support Services Application Delaware Tribe” is a detailed form used by the Delaware Tribe of Indians to collect necessary information for processing child support cases. It requires personal, contact, employment, and tribal affiliation details for both custodial and non-custodial parents, as well as information about each child involved, including legal name, birth details, school, and paternity status. The application addresses issues such as domestic violence, public assistance history, and prior court actions related to child support, custody, and paternity. Applicants must submit supporting documents like birth certificates, CDIB cards, social security cards, court orders, and a driver’s license. The form includes affidavits regarding child support payments, a statement of understanding about responsibilities and confidentiality, a financial affidavit, and sections for office use and case transfers, all requiring signatures and notarization. The process emphasizes accuracy, cooperation, and the legal responsibilities of participating in the tribal child support program.

  • Child Custody Intake Form Colorado River Indian Tribes

    The “Child Custody Intake Form” for the Colorado River Indian Tribes Legal Aid Department is an application used to request legal assistance for child custody and related family law matters. Applicants must be enrolled or eligible for enrollment with the tribe and provide detailed personal, contact, and case information, including the current custody situation, details about the other parent, any existing court cases, and information about the children involved. The form collects preferences for custody and visitation arrangements, including options for joint or sole custody, supervised or unsupervised visitation, and holiday schedules. It also asks about any history of domestic violence or sex offender status for both parents. Applicants are notified of a $65 court filing fee, with a possible waiver, and must agree to update their contact information and waive certain privacy rights during representation. The form is designed to identify conflicts, gather necessary background, and support the provision of legal aid services for child custody cases within the CRIT community.

  • Adoption Intake Form Washoe Tribe

    The “Adoption Intake Form” for the Washoe Tribe is a detailed document designed to collect comprehensive information necessary for adoption proceedings. It gathers data about the social worker, prospective adoptive parents (including personal, background, and contact information), and each child to be adopted, such as their identifying details, special needs status, Indian Child status and tribe, and placement history. The form also addresses legal aspects like the termination or relinquishment of parental rights, post-adoptive agreements, and sibling contact agreements, ensuring all relevant legal and familial considerations are documented for the adoption process.

  • Parent Health (Osage Nation)

    The document is a supplemental questionnaire from the Osage Nation Child and Family Assessment designed to collect comprehensive information about the health of parents or guardians. It covers topics such as overall health status, reasons for health ratings, allergies, disabilities, chronic illnesses, current medications, sources of medical care, insurance coverage, and frequency of medical and dental visits. The form also addresses mental health history, including experiences with depression, counseling, mental health evaluations, thoughts of self-harm, and suicide attempts, as well as physical limitations. Additional questions inquire about family history of diabetes and alcohol problems, and there is space for comments or questions regarding health or available resources and services. The questionnaire appears multiple times, indicating its use as a template for multiple individuals.

  • Education (Osage Nation)

    The document is a supplemental education questionnaire used by Osage Nation Social Services to assess children’s educational experiences as part of a child and family evaluation. It collects information on school enrollment status, reasons for non-enrollment, participation in GED or special education programs, learning disabilities, academic performance, grades, attitudes toward school, future educational plans, subjects of strength and difficulty, attendance, disciplinary history, involvement in activities or sports, and relationships with teachers and peers. The form also includes space for comments or questions about educational resources and services, aiming to provide a comprehensive view of both academic and social aspects of a child’s school life.

  • Child Well-Being (Osage Nation)

    The document is a supplemental questionnaire from Osage Nation Social Services used to assess child well-being as part of a broader child and family assessment. It gathers information on children’s physical health, including allergies, disabilities, chronic illnesses, prescribed medications, access to medical care, insurance coverage, and the frequency of medical and dental checkups. The form also addresses mental health by asking about depression, counseling, mental health evaluations, and any history of self-harm or suicide attempts. Additional sections inquire about physical limitations, how children spend their free time, their hobbies and interests, and opportunities for further engagement, with space provided for parents or guardians to comment on their children’s health and available services or resources.

  • Child Behaviors (Osage Nation)

    The “Child Behaviors (Osage Nation)” document is a supplemental questionnaire used by Osage Nation Social Services to assess child behaviors during child and family evaluations. It contains questions for caregivers about the child’s involvement in physical altercations, assaults, weapon use, gang activity, running away, staying out all night, legal issues such as pending charges or arrests, probation status, and interactions with law enforcement or juvenile authorities. The form also requests explanations and details about specific incidents, consequences or punishments, probation conditions, and provides space for additional comments or questions regarding the child’s behavior and available support services.