Permission to Screen for Reports of Child Abuse or Neglect

This form is to be completed by individuals who are applying to work in one of the following types of facilities:

• Residential Treatment Center,
• Independent Living Preparation Program,
• Group Care Center for Minors,
• Child Placement Agency,
• Foster Home,
• Adoption,
• Day Care Center,
• Head Start Program,
• Family Day Care Home,
• Group Family Day Care Home,
• Before and After School Center, or
• Relative Placement for a child currently in foster care.
• The form may also be completed by individuals applying to work in a facility for which licensure as a child welfare agency has been waived.

When a person applies to work in one of the above facilities or for foster home licensure or adoption approval, they are required to complete the form. This form allows permission to screen for reports of child abuse and neglect against the Central Registry of Child Abuse and Neglect.

If applying to work in a facility, the individual must complete the form and return it to the facility, which is then submitted to the Division of Child Protection Services. If applying to be licensed as a foster parent or approved for adoption, the individual should complete the form and return it to his or her Family Services Specialist for processing.

A set of instructions is included with the form. If you have a question about this form, please call (605) 773-3227.