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While these forms can be used for documenting information required by the Minimum Standards, their use is not mandated by Child Care Licensing.
Click on 'PDF' below to download the Adobe Acrobat version of a form or on 'DOC' to download the Microsoft Word version. Use 'CTRL + F' to find specific form titles.
DFPS Privacy and Security Policy | DFPS Política de Confidencialidad
| Number | Form Name | Description of Use for Providers |
|---|---|---|
| Address Correction Form for Licensed Child Care Administrators and Licensed Child-Placing Agency Administrators (pdf, doc) | ||
| Discipline and Guidance Policy (pdf, doc) | Texas Administrative Code, Title 40, Chapters 746 and 747, Subchapters L, Discipline and Guidance | |
| 7239 | Incident/Illness Report (pdf, doc) | Details of incident that caused injury or placed child at risk. |
| 1100 | Daily Building & Grounds Safety Checklist (pdf, doc) | |
| 2760 | Controlling Person Form (pdf) (doc) | Required for Residential Operations to identify who is ultimately responsible for complying with standards and keeping children safe. |
| 2784 | General Residential Operation and Residential Treatment Center Documentation Required at Application (pdf, doc) | Additional Guidelines for Materials Required to Accept Application |
| 2785 | Child-Placing Agency Documentation Required at Application (pdf, doc) | Additional Guidelines for Materials Required to Accept Application |
| 2786 | Independent Foster Home Documentation Required at Application (pdf, doc) | Additional Guidelines for Materials Required to Accept Application |
| 2821 | Exemption Determination (pdf, doc) | |
| 2841 | SEBCC Application Form (pdf | doc) | |
| 2842 | SEBCC Application Inspection Letter (pdf | doc ) | |
| 2843 | SEBCC Issuance Letter (pdf | doc) | |
| 2846 | Gang Free Zone Tip Sheet for Providers and Parents (pdf, doc) | House Bill 2086 passed during the 81st Legislature, Regular Session, modified Chapter 42 of the Human Resource Code to include Section 42.064, effective September 1, 2009. This new statute requires that information about gang-free zones be distributed to parents and guardians of children in care at licensed child care centers. |
| 2846s | Nuevos requisitos sobre las zonas libres de pandillas en los centros de cuidado de niños (pdf, doc) |
|
| 2885 | Children's Products Certification (pdf | doc) | |
| 2906 | CPA Internal Investigation Report (pdf, doc) | Voluntary form for CPA internal investigations. |
| 2911 | Governing Body/Director Designation (pdf, doc) | "Texas law gives you the right to know what information is collected about you by means of a form you submit to a state government agency...." |
| 2934 | Medical History Report (doc, pdf) | New legislation requires a parent who voluntarily relinquishes their parental rights of their biological child and parents whose rights are terminated to complete this form describing theirs and their ancestors medical history. |
| 2935 | Admissions Information - Centers (pdf, doc) (Spanish: pdf, doc) (includes Authorization for Emergency Medical Treatment) |
Facilities must keep certain information for licensing regulations and the Child & Adult Care Food Program (CACFP). This form prevents duplication of effort by providers by keeping only 1 enrollment form for both programs. The CACFP program requires enrollment information to be updated annually. By using this form, parents may give clear instructions for emergency medical treatment for their children. |
| 2937 | Child Care Waiver/Variance Request Form (pdf, doc) | To request a Minimum Standard waiver or variance |
| 2940 | Child Care Administrative Review Request Form (pdf, doc) | To request an administrative review |
| 2941 | Child Care Operation Sign In-Out Log (pdf, doc) | |
| 2946 | Local Law Enforcement Background Check Results for Prospective Foster Parents (doc) | |
| 2947 | Child Care Center Personnel Information Record (pdf, doc) | This information is required by rule and simplifies form completion for providers to have records available. |
| 2948 | Plan Of Operation For Licensed Child-Care Operations (pdf, doc) | |
| 2949 | General Residential Operation Standards (xls) | Guidelines for Materials Required Prior to Issuance |
| 2950 | Child-Placing Agency Standards (xls) | Guidelines for Materials Required Prior to Issuance |
| 2951 | Independent Foster Home Rules: Evaluated Prior to Issuing an Initial License to a Non-Operating Home (xls) | |
| 2954 2954s |
Disclosure of Any Family Violence Calls to a Prospective Foster Home Applicants Place of Residence (doc) In Spanish (doc, pdf) |
|
| 2955e |
Licensing Fee Information (pdf, doc) Spanish: (pdf, doc) | This is an informational form to let providers know the various fees and requirements of TDFPS. |
| 2957 | Parent Notification Poster for Center Based Care (pdf, doc) | This poster list information you are entitled to see as required from the center Director. |
| 2957b | Parent Notification Poster for Home Based Care (pdf, doc) | This poster list information you are entitled to see as required from the primary caregiver. |
| 2958 | Keeping Children Safe Poster (All PDF) English Color | English B&W Spanish Color | Spanish B&W |
|
| 2961 | Request to Accept Children from Law Enforcement (doc, pdf) | This form must be submitted by a Child Placing Agency prior to them accepting children from a Law Enforcement Officer. |
| 2963 | FAST Pass for Foster Adoptive Applicants (pdf) | (doc) |
Required Materials to Grant Services |
| 2965 | FAST Pass for Day Care & 24-Hour Residential Child Care Staff (pdf) | (doc) |
Required Materials to Grant Services |
| 2869 | Listed Family Home introduction letter (pdf | doc) | |
| 2971 |
Request for Criminal History check/Central Registry Check (pdf, doc); Spanish: (doc, pdf) | This information is required by DFPS and simplifies form completion for providers. Reduces errors in the information that must be presented to request these checks. |
| 2873 | Guidelines for listed family homes (pdf | doc) | |
| 2982 | Personal History Statement - CPA (pdf, doc) | This information is required by DFPS and simplifies form completion for providers. |
| 2985e 2985s |
Affidavit for Applicants for Employment With a Licensed Operation or Registered Child-Care Home (pdf, doc) Spanish: (pdf, doc) |
This information is required by law and simplifies form completion for staff of providers. |
| 2986 | Listing request (pdf, doc) Spanish: (pdf, doc) |
Form to become a listed home |
| 2987 | No Contact Letter to CPA (pdf, doc) |
|
| 2988A | Child Care Fee Schedule (pdf, doc) Spanish: (pdf, doc) | This form needs to be submitted with any type fee for all regulated facilities. |
| 2993 | Administrative Penalty Fee form (pdf, doc) | Administrative Penalty Fee Form |
| 3001 | CPA Foster Parent Rights (pdf, doc) | |
| 3002 | Independent Foster Home Rights (pdf, doc) | |
| 3003 | Foster Home Evaluation Checklist (pdf, doc) | |
| 7238 | Authorization For Dispensing Medication (pdf, doc) | This information is required by DFPS and simplifies form completion for providers. |
| 7240 | Monthly Attendance Record (pdf, xls) | This information is required by DFPS and simplifies form completion for providers. |
| 7242 | Registered Family Home Caregiver/Parent Agreement (pdf, doc) | |
| 7243 | Emergency Telephone Numbers RFH (pdf, doc) | This information is required by DFPS and enables providers to post information in a readable manner. |
| 7255E 7255s |
Medication Authorization Form (pdf, doc) Spanish: (pdf, doc) | Medication Authorization Form |
| 7261 | Information on Reporting Child Abuse (pdf, doc) | This form gives information to those who suspect child abuse and enables providers and parents to know the law. |
| 7263 | Fire Safety Practices (pdf, doc) | |
| 7293 | Child Assessment Form (pdf, doc) |
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