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DSHS Form 09-004C CA Voluntary Placement Agreement for Child or Youth With Developmental Disabilities - Washington (Cambodian)
This is a legal form that was released by the Washington State Department of Social and Health Services - a government authority operating within Washington.
The document is provided in Cambodian. As of today, no separate filing guidelines for the form are provided by the issuing department.
FAQ
Q: What is DSHS Form 09-004C?
A: DSHS Form 09-004C is the Voluntary Placement Agreement for Child or Youth With Developmental Disabilities in Washington (specifically for Cambodian ethnicity).
Q: Who is this form for?
A: This form is for parents or legal guardians who wish to voluntarily place a child or youth with developmental disabilities in a residential facility in Washington.
Q: What is the purpose of this form?
A: The purpose of this form is to document the voluntary placement agreement between the parents or legal guardians and the residential facility for the care and support of the child or youth with developmental disabilities.
Q: Is this form specific to the Cambodian community?
A: Yes, this form is specifically designed for the Cambodian community in Washington.
Q: Are there any fees associated with submitting this form?
A: There are no fees associated with submitting this form.
Q: Can this form be used for non-Cambodian individuals?
A: No, this form is specifically intended for individuals of Cambodian ethnicity in Washington.
Q: What information is required in this form?
A: The form requires information about the child or youth with developmental disabilities, the parents or legal guardians, the residential facility, and the planned placement details.
Q: How long is the placement agreement valid?
A: The placement agreement is valid for the duration specified in the form, which can be reviewed and extended periodically.
Q: Can the placement be terminated before the agreed duration?
A: Yes, the placement can be terminated by either party before the agreed duration, as specified in the form and subject to the terms and conditions.
Form Details:
- Released on December 1, 2013;
- The latest edition provided by the Washington State Department of Social and Health Services;
- Easy to use and ready to print;
- Quick to customize;
- Compatible with most PDF-viewing applications;
Download a printable version of DSHS Form 09-004C CA by clicking the link below or browse more documents and templates provided by the Washington State Department of Social and Health Services.
Download DSHS Form 09-004C CA Voluntary Placement Agreement for Child or Youth With Developmental Disabilities - Washington (Cambodian)
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