Placement Forms Resource

Go to the Pre-Service Module on Court, Section 1, Navigating the Court Process, for a quick description of the correct forms for the specific reason for removal. The forms you will be using are listed and linked below.

Chapter 48

• Temporary Physical Custody Request: JC-1608 , Form Summary
• Temporary Physical Custody Request Supplement: JC-1609 , Form Summary
• Dispositional Order – Protection or Services: JC-1611 , Form Summary
• Notice of Change in Placement: JC-1754 , Form Summary
• Temporary Physical Custody Hearing Preparation Guide – Chapter 48: Guide

Chapter 938

• Temporary Physical Custody Request: JD-1710 , Form Summary
• Court Order: JD-1711 , Form Summary
• Change of Placement Notice: JD-1754 , Form Summary
• Request to Change Placement, Revise Disposition Order, Extend Disposition Order, Review Permanency Plan: JD-1766 , Form Summary
• Notice of Post-Post Disposition Emergency Change in Placement and Hearing Request (In-Home to Out-of-Home): JD-1767 , Form Summary
• Post-Disposition Emergency Change in Placement Order (In-Home to Out-of-Home): JD-1768 , Form Summary
• Order for Change in Placement (In-Home to Out-of-Home): JD-1789 , Form Summary
• Order for Change in Placement (Out-of-Home to Out-of-Home): JD-1790 , Form Summary

Indian Child Welfare

• Notice of Change in Placement – ICWA: IW-1754 , Form Summary
• Request to Change Placement, Revise Dispositional Order, Extend Dispositional Order, Review Permanency Plan – ICWA: IW-1766 , Form Summary
• Order for Change of Placement (In-Home to Out-of-Home) – ICWA: IW-1789 , Form Summary
• Order for Change of Placement (Out-of-Home to Out-of-Home) – ICWA: IW-1790 , Form Summary

Voluntary Placement Agreement forms

• English
• Hmong
• Spanish
• Indian Child

When a child is placed in out-of-home care under chs. 48 or § 938, the agency having “placement and care responsibility” must ensure that all laws and policies related to children in out-of-home care are adhered to.

At the time of placement the caseworker is responsible to ensure that all necessary legal documents and notifications are made to the child, their parents, the out-of-home provider, relatives, and the legal community. (Ongoing Standards)

Placement Agreement

• Foster Home Agreement Child Placed in Out-of-Home Care by Agency
• Relative Caregiver Agreement Child Placed in Out-of-Home Care by Agency: English , Hmong , Spanish

Notice

Notify all adult relatives that the child or juvenile has been placed into out-of-home care. Anytime that a child or juvenile is removed from their parent(s)’ home under a court order and is not returned within 30 days, the notice must be sent.

• Notification of the Removal of a Child from the Custody of His or Her Parent and Placement into Out-of-Home Care: English , Spanish

Information and Consents to Provide to Physical Custodian

• Provide information to the physical custodian of the child (child’s out-of-home care provider) as required under §. 48.371, Stats. upon placement, but no later than 48 hours if unknown to the agency at the time of placement:
  • Information to Out-of-Home Care Providers: Part A, Part B
• Obtain signed consents for:
  • Medical Services Consent: English, Hmong, Spanish
  • Relatives and other informal supports
  • Other service providers the child may be utilizing including, but not limited to school, child care facility, therapists, physicians, private agencies involved, etc.
• Obtain medical services coverage either through the health insurance of the child’s parent or Medicaid.
  • Ensure that parents and relative caregivers are aware of eligibility changes to Medicaid when a child is removed from or enters their care:
    The Certification of Foster Care Medicaid,
    Medicaid Coverage Information

Child Identifies as Indian

If a child is identified as an Indian child and WICWA applies, the agency is required to notify the child’s tribe within 24 hours the child’s name and address or expectant mother’s name and address.

• Notification is completed by sending the following forms to the child’s tribe:
  • Screening for Child’s Status as Indian
  • Child’s Biological Family History
  • Request for Confirmation of Child’s Indian Status
• Notify the clerk of the school district in which a foster home is located when a school-age child is placed in that foster home, as required under §. 48.64 (1r), Stats. The notification shall include all of the following:
  • The name, address, and phone number of the foster parent.
  • The name of the foster child.
  • Information about the child required by the school, as allowed under any applicable confidentiality laws.
• Ensure the child is properly enrolled in an educational setting as required by law.
• Document the child’s placements into out-of-home Care into eWiSACWIS within five days.

• Placement Documentation Manual
  The primary purpose of this manual is to clarify eWiSACWIS placement documentation requirements for child welfare staff, supervisors and managers. The manual is divided into four main components as follows:
  • Core Principles to Placement Documentation
  • Key Terms and Definitions for Placement Documentation
  • Contact Information for Placement-Related Documentation
  • “How Do I” Guides by Placement Setting (Appendix)
• Creating an Out-of-Home Placement
• Ending an Out-of-Home Placement
• Notification of Placement

There are several sites that have other forms related to out-of-home placement.

• Forms and Form Search
• Wisconsin Indian Child Welfare Forms

Education Section

• Children/Youth in Out-of-Home Care and Education
• Promoting School Success for Foster Children – A Desk Guide for Caseworkers
• Education Passport
• Education Passport Example

Youth in Out-of-Home Care Section

• Handbook for Youth in Out-of-Home Care

• Kinship Care Info Sheet
• Kinship Resources and Needs
• Portal to Kinship forms in English, Spanish, and Hmong