{"id":2528,"date":"2019-03-21T14:19:35","date_gmt":"2019-03-21T19:19:35","guid":{"rendered":"http:\/\/devwp.tribalinformationexchange.org\/?page_id=2528"},"modified":"2024-02-07T13:01:19","modified_gmt":"2024-02-07T18:01:19","slug":"intakeandassessmentforms","status":"publish","type":"page","link":"https:\/\/tribalinformationexchange.org\/index.php\/intakeandassessmentforms\/","title":{"rendered":"Intake & Assessment Forms"},"content":{"rendered":"

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Intake & Assessment Forms<\/h1>\n

[\/et_pb_text][et_pb_divider color=”#ffffff” divider_weight=”4px” disabled_on=”off|off|off” _builder_version=”4.16″ background_size=”initial” background_position=”top_left” background_repeat=”repeat” max_width=”40px” module_alignment=”left” custom_margin=”||10px|” animation_style=”zoom” animation_direction=”left” saved_tabs=”all” locked=”off” global_colors_info=”{}”][\/et_pb_divider][et_pb_text _builder_version=”4.16″ text_font=”||||||||” text_text_color=”#ffffff” text_font_size=”16px” text_line_height=”1.9em” animation_style=”zoom” animation_intensity_zoom=”6%” locked=”off” global_colors_info=”{}”][\/et_pb_text][\/et_pb_column][\/et_pb_row][\/et_pb_section][et_pb_section fb_built=”1″ admin_label=”Features” _builder_version=”4.16″ custom_margin=”|||” custom_padding=”25px|0px|46px|0px|false|false” global_colors_info=”{}”][et_pb_row _builder_version=”4.23.1″ _module_preset=”default” min_height=”278.4px” custom_margin=”||-39px||false|false” global_colors_info=”{}”][et_pb_column type=”4_4″ _builder_version=”4.23.1″ _module_preset=”default” global_colors_info=”{}”][et_pb_tabs _builder_version=”4.23.4″ _module_preset=”default” body_font_size=”16px” body_line_height=”1.8em” tab_font=”Montserrat||||||||” tab_font_size=”16px” global_colors_info=”{}”][et_pb_tab title=”Intake and Assessment” _builder_version=”4.23.4″ _module_preset=”default” body_font_size=”16px” global_colors_info=”{}”]<\/p>\n

Adoption Intake Form<\/a> (Washoe Tribe of Nevada and California) <\/strong>– An adoption intake form with information about adoptive parents and children.<\/p>\n

Child Abuse and Neglect <\/a>Assessment (Sac and Fox Nation)<\/strong> – A modifiable child abuse and neglect assessment including income and expenses and space for case notes.<\/p>\n

Child and Family Assessment<\/a> (Osage Nation) <\/strong>– A brief questionnaire about the family, including contact information, housing, budget, and parenting styles.<\/p>\n

Child Intake Form<\/a> (Rosebud Sioux Tribe)<\/strong> – An evaluation report about the Rosebud Sioux Tribe’s Defending Childhood Initiative; a draft child intake form is on page 35.<\/p>\n

Child Support Services Application<\/a> (Delaware Tribe of Indians)<\/strong> – A child support services application outlining parent and child information, child support payments, and a financial affidavit.<\/p>\n

Family Violence Services Intake Form<\/a> (Citizen Potawatomi Nation)<\/strong> – An intake form for family violence services, including assistance request, perpetrator description, history of abuse, and legal information.<\/p>\n

Home Assessment<\/strong> <\/a>– A modifiable home assessment form.<\/p>\n

Legal Aid Application<\/a> (Colorado River Indian Tribe) <\/strong>– An application for legal services, including a child custody supplement.<\/p>\n

Program Eligibility Determination<\/strong><\/a> – A modifiable program eligibility determination template.<\/p>\n

[\/et_pb_tab][et_pb_tab title=”Supplemental Questionnaires” _builder_version=”4.23.4″ _module_preset=”default” body_font_size=”16px” global_colors_info=”{}”]<\/p>\n

Alcohol\/Drug At-Risk Behavior Survey<\/a> (Osage Nation)<\/strong> – A survey to assess if a child may have substance abuse issues.\u00a0<\/p>\n

Child Behaviors Questionnaire<\/a> (Osage Nation)<\/strong> – A questionnaire for documenting a child’s behavior.<\/p>\n

Child Well-Being Questionnaire<\/strong><\/a> (Osage Nation)<\/strong> – A questionnaire for documenting a child’s well-being, medical history, and interests.<\/p>\n

Education Questionnaire<\/a> (Osage Nation)<\/strong> – A questionnaire for documenting a child’s education.<\/p>\n

Parent\/Guardian Health Questionnaire<\/a> (Osage Nation)<\/strong> – A brief health questionnaire for parents\/guardians.<\/p>\n

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Intake & Assessment FormsAdoption Intake Form (Washoe Tribe of Nevada and California) – An adoption intake form with information about adoptive parents and children. Child Abuse and Neglect Assessment (Sac and Fox Nation) – A modifiable child abuse and neglect assessment including income and expenses and space for case notes. Child and Family Assessment (Osage […]<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_et_pb_use_builder":"on","_et_pb_old_content":"","_et_gb_content_width":"","footnotes":""},"class_list":["post-2528","page","type-page","status-publish","hentry"],"yoast_head":"\nIntake & Assessment Forms - Tribal Information Exchange | Capacity Building Center for Tribes<\/title>\n<meta name=\"description\" content=\"The Center for Tribes designs & delivers tools & resources for American Indian & Alaska Native child welfare professionals to support the well-being of tribal communities.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/tribalinformationexchange.org\/index.php\/intakeandassessmentforms\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Intake & Assessment Forms - 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