Exhibit 3- Support Network Contact Sheet CSO-4500.pdf

128 KB Posted

Attached to
Master Agreement AZ|CTR076697
Contract number
CTR076697
Issued by
Arizona

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The document is a Support Network Contact Sheet from the Arizona Department of Child Safety (DCS), specifically for the Fostering Sustainable Connections (FSC) program, identified by the code CSO-4500. It is a blank form designed for recording contact information for individuals who are part of a support network, with columns for Name, Relationship, Phone Number, Email Address, and Notes/Comments.

The form includes standard equal opportunity employment language, emphasizing non-discrimination policies and providing accessibility information. It offers free language assistance and TTY/TDD services, demonstrating the department's commitment to inclusive communication. The contact sheet is intended to help track and manage support networks for child welfare purposes, allowing for comprehensive documentation of key contacts related to a child's case or placement.

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Support Network Contact Sheet

Fostering Sustainable Connections (FSC) CSO-4500 (01/25)

Equal Opportunity Employer/Program. The Department of Child Safety (DCS) prohibits discrimination in admissions, programs, services, activities, or employment based on race, color, religion, sex, national origin, age, disability, genetics, or retaliation or any other status protected by federal law, state law, or regulation. Reasonable accommodations to allow a person with a disability to take part in a program, service, or activity are available upon request. To request this document in alternative format or for further information about this policy contact your local office. TTY/TDD Services: 7-1-1. Free language assistance for DCS services is available upon request. Ayuda gratuita con traducciones relacionadas con los servicios del DCS esta disponible a solicitud del cliente.

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