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Growing Kinship Connection
Referral Form

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Growing Kinship Connection: Referral Form

This form is designed to refer a child to the Growing Kinship Connection (GKC) program. The GKC program aims to educate and help Kin Caregivers, Fathers, and non-biological relatives navigate the Child Protection and Welfare system in St. Louis County, Minnesota.

Referral Source

This section allows you to select the type of referral
Referred by?

Community Provider Information

This section will capture the basic information of the Community provider referring this case.
Community Provider's First & Last name
Would You Like To Provide Social Worker's Information?

Self-Referral

This section will capture any additional information that might not have been captured before.
Are You The Father/Mother?
You will provide your information in a later section.
Are You A Kin?
Kin's Name
Kin's Address
Your Name
Your Address
Would You Like To Provide Social Worker's Information?

Social Worker Information

This section will capture the basic information of the social worker(s) working on this case.
Social Worker's First & Last Name

Child's Bio

This section will collect basic information for the child being referred.
Child's First & Last Name
Child's Date of Birth
Child's Gender
Child's Race
Is this an Indian Child Welfare Act (ICWA) Case?
Child's Physical Address
Is this Child Located in St. Louis County?
Child's Emergency Contact Name
Do You Want To Add Another Child Information For This Referral?
Additional Child Information
Additional Child's Name
Additional Child's Date Of Birth
Additional Child's Address
 

Child's Placement Information

This section will capture information pertaining to the child's current placement.
Is This Child Placed With A Kin Caregiver?
Is This Child Placed With Foster Parents?
Does This Child Has Stable Housing?
Additional Details

Kin CareGiver Placement Information

This section will capture Kin's information with whom the child's placed.
Kin Caregiver's First & Last Name
Kin Caregiver's Physical Address
Kin Caregiver's Date of Birth
Are You A ...?

Foster Parent(s) Information

Foster Parent 1 Name
Foster Parent 2 Name
Foster Parent's Physical Address

Parent's Information

Capture Father & Mother's information
Would You Like to Add Mother's Information?

Mother's Information

This section will capture the Mother's information.
Mother's First & Last Name
Mother's Physical Address
Mother Has Stable Housing?
Additional Details
Do You Have the Father's Information to Add?

Father's Information

This section will capture the Father's information.
Father's First & Last Name
Father's Physical Address
Father Has Stable Housing?
Additional Details
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    Growing Kinship Connection

    [email protected]

    Growing Kinship Connection is an initiative of Family Rise Together. Family Rise Together is a 501(c)(3) nonprofit organization

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