Exhibit E DCS-1227C Closure Report.pdf
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- Attached to
- Master Agreement AZ|CTR056498
- Contract number
- CTR056498
- Issued by
- Arizona
About this file
This document is a Child Specific Recruitment (CSR) Closure Report from the Arizona Department of Child Safety (ADCS). The form is designed to document recruitment efforts for placing a specific child in a permanent home, potentially through adoption, guardianship, or other permanent connections. The report involves tracking recruitment activities, potential placement strategies, and outcomes for children in the child welfare system.
The form captures detailed information about recruitment activities, including AdoptUSKids registration, media releases, case file review, communication with current and past caregivers, obtaining child photographs, profile preparation, and specific recruitment activities like flyers or narratives. The document includes sections to record whether the child is part of a sibling group, placement status, and whether organizations like AdoptUSKids or Children Heart Gallery played a role in identifying the placement. The form serves as a comprehensive tracking mechanism for child-specific recruitment efforts, allowing the agency to document and evaluate the strategies used to find permanent homes for children in the child welfare system.
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Did AdoptUSKids or Children Heart Gallery play a role in identifying the placement?
CHILD SPECIFIC RECRUITMENT (CSR) CLOSURE REPORT
ARIZONA DEPARTMENT OF CHILD SAFETY
DCS-1227C
(04/20)
Agency Assigned
Name of Recruiter Assigned
Date of Referral Second 90 Day CSRP DueDate Initial CSRP Due Subsequent 90 Day Follow-up CSRP Due
Date of Birth
Date Date
Child’s NamePhone No.
CHILD’S PID# JD#
Child Information ~ Complete one form for each child. Submit sibling groups together.
Finalized CSR ~ Incomplete plans will be denied and returned to contractor.
Completed Recruitment Activities
Yes Yes
Yes
No No
No
Is the child part of a sibling group? If yes, are the siblings to be placed together?
What was successful that can/should be incorporated in other CSRs?
Closed by ADCS
Adoption Finalized Guardianship FinalizedChild Placed
Permanent Connection Found
Activity Date Completed Additional Information AdoptUSKids Registration
Media Release (acquired by the assigned DCS Specialist)
Access to the child’s case file to “Mine” for information; if so, what resulted from the file dig? Number of past placements with relatives/fictive kin discovered?
Talk to current/past caregivers about their willingness to adopt Obtain a recent photograph of the child of high resolution or obtained by Children Heart Gallery photo shoot Prepare/update the child’s profile
Specific recruitment activities (e.g., flyer, narrative, etc.);
submit for DCS approval Other:
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