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Home / Child-Specific Recruitment Services

Child-Specific Recruitment Services

Child-Specific Recruitment Referral

We appreciate your time in helping us gather information regarding the youth!

Step 1 of 10

10%

Youth Information

Name
MM slash DD slash YYYY
Note: A separate referral form will need to be completed for each sibling
Note: We are unable to recruit for youth separate from siblings if there has not been a court-ordered separation.

Referring Social Worker's Information

Name

Other Workers Involved

Name

Name

Name

Youth's Current Living Situation

Address

School Information

Placement History

MM slash DD slash YYYY
MM slash DD slash YYYY
MM slash DD slash YYYY

Termination of Parental Rights

Parent 1
MM slash DD slash YYYY
Parent 2
MM slash DD slash YYYY

Assessment & Diagnosis Information

Please List Any Of The Following (if applicable):

Mental Health Diagnoses
Physical Disabilities
Corrections History

Birth Family Information

Recruitment Services

Please Share the Top 3 Reasons It Has Been Challenging to Find a Family For This Youth:
Please Provide Any Information On Previous Recruitment Efforts (check all that apply):
MM slash DD slash YYYY

Please Attach a Copy of the Following

Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.
Max. file size: 50 MB.

I verify that, at a minimum, the following activities have been completed and that this/these youth are therefore eligible to receive child-specific recruitment services under the Public Private Adoption Initiative Contract. (1) A relative/kinship search according to the policies & procedures as required by statute. (2) The child or sibling group has been registered on the State Adoption Exchange (SAE).

If these have not been completed, please contact us to discuss when they can occur ([email protected] | 651.255.2275)
Your Name
This field is for validation purposes and should be left unchanged.

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1605 Eustis Street
Saint Paul, MN 55108
651.646.7771
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