ࡱ>   @ 8Qbjbj  *$RRRRRRRf4448|$f0x,5777778\90D2iwiwiwiwiwiw$\yR{w]R79777979wRR77wi;i;i;79"R7R7Di;79Di;i;+>RR>7 hH4Y9">?,x00x>L|{9L|(>ffRRRRL|R>7979i;7979797979wwff$S;ff$PRELIMINARY ADOPTIVE FAMILY ASSESSMENTAdoption Services Michigan Department of Human ServicesAPPLICANT INFORMATIONMother s NameDate of Birth FORMTEXT       FORMTEXT      Father s NameDate of Birth FORMTEXT       FORMTEXT      AddressPhone Number FORMTEXT      ( FORMTEXT    )  FORMTEXT      Name of child(ren) available for adoption)Date of Birth FORMTEXT       FORMTEXT      OTHER HOUSEHOLD MEMBERSChildren in the HomeChild s NameDate of Birth FORMTEXT       FORMTEXT      Relationship to Applicant (birth, foster, guardianship, etc.) FORMTEXT      Adults in the Home (other than applicants)Adults NameDate of Birth FORMTEXT       FORMTEXT      Relationship to Applicant Include Parenting Responsibilities (if any). FORMTEXT      DATES OF CONTACTDatesWith whom (include role/position)Type (HV, TC, OV) FORMTEXT       FORMTEXT       FORMTEXT      RELATIONSHIP WITH CHILD What is the family history with this child? What has been the frequency of contact with the child? Reason that the child is not already placed with this family. FORMTEXT      MOTIVATION TO ADOPT FORMTEXT      SOCIAL HISTORY OF APPLICANTS (self reported)MaternalFull name Personal History (education, employment, military, health history, relationship with family of origin, siblings) Parenting History Any history of crime, Childrens Protective Services involvement, substance abuse, psychiatric hospitalizations, other mental health problems, domestic violence involvement or proceedings FORMTEXT      Paternal Assess same as above. FORMTEXT      Living Together Partner (same as maternal) FORMTEXT      FINANCIAL (Self Reported) Sources and amounts of income. Financial obligations. Assessment of the family s ability to meet its own. 0 D F H R T V X l n p z | ~   8 : N P R \ ^ b d x z |  jAh)Ujh)Ujah)Ujh)UjKh^nU h)5jh)Ujhqr%UmHnHujh)Ujh)Uh)8NPt~x@7kd$$If9B+4*4 9aG$If7kda$$If9B+4*4 9aG 'd$If9kd$$If9B+4*4 9aG*$IfPQZ , . 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Child support obligations, if any. FORMTEXT      Home and Community (Self Reported)Description of the home, including number of bedrooms. Length of time the family has lived in this home. Description of the community. FORMTEXT      Additional DocumentationDocumentation is required of any factor leading to a recommendation that the family is not suitable to adopt the child. FORMTEXT      Ability to Meet the Child s NeedsIs the family aware of the needs of the child as identified in the Child Adoption Assessment (and addenda)? Is the family willing and capable of meeting the child s needs? Can the family protect the child from previous abusers (parents, other relatives)? Do the applicant s acknowledge the mistreatment/neglect that led to the necessity to terminate parental rights? FORMTEXT      RecommendationThe recommendation is to apply specifically to the child in question and does not necessarily reflect on the family s suitability to adopt in general. FORMTEXT      Worker SignatureDateAgency NameSupervisor SignatureDateAUTHORITY: P.A. 288 of 1939, as amended, MCLA-710.27(5) COMPLETION: Voluntary. PENALTY: NoneDepartment of Human Services (DHS) will not discriminate against any individual or group because of race, sex, religion, age, national origin, color, height, weight, marital status, political beliefs or disability. If you need help with reading, writing, hearing, etc., under the Americans with Disabilities Act, you are invited to make your needs known to a DHS office in your area. 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TEMPLATEPROJECT.WORKERPHONE.MAIN5!TEMPLATEPROJECT.AUTOSAVE.AUTOSAVE6!TEMPLATEPROJECT.COUNTYNUMBER.MAIN7!TEMPLATEPROJECT.GRANTEESTATE.MAIN8!TEMPLATEPROJECT.NEWMACRO.AUTOOPEN9!TEMPLATEPROJECT.NEWPARAGRAPH.MAIN:"TEMPLATEPROJECT.CLEARCASEINFO.MAIN;"TEMPLATEPROJECT.COPHONENUMBER.MAIN<"TEMPLATEPROJECT.COSUPPADDRESS.MAIN="TEMPLATEPROJECT.GRANTEECAREOF.MAIN>"TEMPLATEPROJECT.SUPERAREACODE.MAIN?"TEMPLATEPROJECT.SVCREFHEADING.MAIN@#TEMPLATEPROJECT.ADDSVCREFERRAL.MAINA#TEMPLATEPROJECT.DELETEROW.DELETEROWB#TEMPLATEPROJECT.SUPEREXTENTION.MAINC#TEMPLATEPROJECT.SUPERVISORNAME.MAIND#TEMPLATEPROJECT.WORKERAREACODE.MAINE$TEMPLATEPROJECT.ADDCHILDINFOROW.MAINF$TEMPLATEPROJECT.GRANTEEADDRESS1.MAING$TEMPLATEPROJECT.GRANTEECLIENTID.MAINH$TEMPLATEPROJECT.GRANTEELASTNAME.MAINI$TEMPLATEPROJECT.WORKEREXTENSION.MAINJ%TEMPLATEPROJECT.GRANTEEFIRSTNAME.MAINK%TEMPLATEPROJECT.SUPERPHONENUMBER.MAINL&TEMPLATEPROJECT.NEWMACRO.CHECKSECTIONSM&TEMPLATEPROJECT.NEWMACRO.CHECKSPELLINGN(TEMPLATEPROJECT.MODULE1.FORMSSPELLCHECK2O)TEMPLATEPROJECT.NEWMACRO.FORMSSPELLCHECK2P-TEMPLATEPROJECT.CHILDAVAILABLE.CHILDAVAILABLEQ/TEMPLATEPROJECT.ADULTSINTHEHOME.ADULTSINTHEHOMER/TEMPLATEPROJECT.DATESOFCONTACTS.DATESOFCONTACTSS1TEMPLATEPROJECT.ADDIDENTINFOAUTO.ADDIDENTINFOAUTOT3TEMPLATEPROJECT.CHILDRENINTHEHOME.CHILDRENINTHEHOME@ AXdd pp ppp$@ppDUnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New5& zaTahoma"h҆҆+J&    r c#4d T3H?)0DHS-1926, Preliminary Adoptive Family AssessmentCompbushd2(       nL@LNormal#CJ OJQJ_HmHnHsH tH uDAD Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List VV Address1d8(OJQJ_HkHOh+'0 , H T ` lx4DHS-1926, Preliminary Adoptive Family AssessmentComp DHS-1926bushd22Microsoft Word 10.0@@R@UH@UH  ՜.+,0( hp  State of Michigan  1DHS-1926, Preliminary Adoptive Family Assessment Title  !"#$%&'()*+,-./012345679:;<=>?@ABCDEFGHIJKLMOPQRSTUVWXYZ[\]^_`abcdefghijklmnopqrstuvwxyz{|}~ Root Entry F&hHEData 8X1TableNWordDocumentSummaryInformation(DocumentSummaryInformation8Macros\ZhHhHVBA'hHhHdirUnit  9CoZip HDate1  W  !"#$%&'()*+,-./012345678:;<=>?@ABCDEFGIJKLMNOPQRSTUVXYZ[\]^_`abcdeghijklmnopqrstvwxyz{|}~0* pHdTemplateProjectQH@  = | MWC J< 9stdole>stdoleP h%^*\G{00020430-C 0046}#2.0#0#C:\WINDOWS\system32\e2.tlb#OLE 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Vof3=Zae1^f4* /roGPE Co7paY C1p"daspY+ /% `aA- ( /!# ClearCaseb51C0s`ub ) /b ࢽ9 ANewParaphNwа ag@&a-h@&? `? /\Stp3 {,SaÄ/3 3 ܴDH1`%0H,"05!0+ countynumberG"ounty umber^2^KG: 5WorkerPhoneGrkPh n  ,2FEFGranteeCityFGaeBCi_FFFCFCoExtensionFCExՀAeIs@#oC#/ C# c#AQ#lientStatDjCl@ A"tS$a%D# E# c#OL# ƍNam#Na@e@K 2U !M!ZipGBˀZHp!G !Q !K!Cb{!?%{!'1aIAreaCod2 Ah6e`2ady2Co%-WPy>Ux&'U%UaseFN$as` N஧&/ S eFaxGeF@3xT.2?!Q0RemoveRow#R mvRw$#/y߂_0lastn 2#ls`nm2$# a ]0First+t0FrAtGt0#?[P7ddresFs39dd":sfo_YC6S19ReW9Gcg /0(B@JkGk'B4Jk@ 92?U?(eL0( L$(?5=cDistrhictsD'/rpc`05G=aBCMInfoCreIfO5=aoA/1A..15=(m%SetctPFi n2__k_Ot@herIDGBOhrDTS __i_NoRese%ݡ N0[ntTS _}5w_?M4QJCoS _us_PrrArD4SW_`s_,K[C*ss`,S _q\`+53G2W`-2CoaBsUa2 HiddeHpPp͓ /  {P#A#@,Dy:!p+(CoC@ityG ,oCityt2:Z(H 1oareOfoareO|foo#o oOFaxACG axAq 2 44Date1Ճ4D4tl1k4 4 44dChildrenInTheHomeG" hldnI(nTejom#2O,O}cK&@Adults+@*uls*2pdO)P)K)B)dIdentInfoAutoG )d(dPn+UUf@A t2*u OT4!N*A%'Sav~B"Svz2#lom4&k`OAvailabl ! COAvi;habe`2.k8?FmsofContactsGFUos@6f`octcOMQ08 (DeleteRoHwGD6lk`R`w&2/a8v+CNewMacr\EaHNwMB"ryicHmoYRW!kMno@ACM Czefa2b3-W>!dk5 :xMEP 0@MWC  " 0Unit  B@oXPiAttribute VB_Name = "Unit" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:=Endv dk5:xMEP 0@MWC  " 0cozip  B@oXPoAttribute VB_Name = "CoZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cDozEndx dk5:xMEP 0@MWC  " 0date1  B@oXPlAttribute VB_Name = "Date1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="dEndx dk5:FaxAC fCareOf uCoCityCounty xMEP 0@MWC  " 0FaxAC  B@oXPjAttribute VB_Name = "FaxAC" Public Sub MAIN() WordBasic.WW7_EditGoTo Destina@tion:=Endx dk5:xMEP 0@MWC  " 0careof  B@oXPqAttribute VB_Name = "CareOf" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coEndz dk5:xMEP 0@MWC  " 0cocity  B@oXPpAttribute VB_Name = "CoCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cocEndz dk5y:xMEP 0@MWC  " 0county  B@oXPnAttribute VB_Name = "County" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=""cEndz 5{:xMEHiddenyWorkerAddRowszCorrect @p(Makes the selection hidden text (toggle)TemplateProject.Hidden.MAIN`MWC  "10DF HJLN@PR0 ptT0 ptVXZ0bArial\^` B@BophxAttribute VB_Name = "Hidden" Public Sub MAIN(X) D.nDescription|Makes the selec,h text (toggle)Pro cDataWInvoke_FuncWTemplaTte"jV..JWordBasic.FormatFont Points:="10", Underline:=0, Color@:=9, SkeThrough SuperjFb<:=1mallCap1)ASpacinBg=0 pt>PosiKernMinTabd ArialBoldIIta End dk5:xMEP 0@MWC  " 0worker  B@oXPlAttribute VB_Name = "Worker" Public Sub MAIN() tdBasic.WW7_EditGoTo Destination:="wEndz 5q:xME @p+Adds row to table FOLLOWING cursor locationTemplateProject.AddRows.MAIN`MWC  "0@ B@XP B@NoH@Attribute VB_Name = "AddRows" Public Sub MAIN() D.pDescription~s row to table FOLLOWING cursor loca\NProcDataZInvoke_FuncZTemplateA"ject..KWordBasic.LineDown 1 TInserBt numSs:="Ends |{5s:xMEh  @2 XMWC  " V*h    ]@Q This serves as a replacement to the spell checker within a protected documentCheck spelling now? %4'2 2 B@0 B@6 B@8@l B@>Hko0Attribute VB_Name = "Correct" Public Sub MAIN() Dim ans Rem This se@rves a replacement to the spell checker within @a proted docu3 ZWordBasic.MsgBox("C?King now ?", 3If4-1en  QATools4UnoDi %St`artOf"S7d>0Pg NoReset:=1, Type:=2 End If CoStateModule1NoReset7OtherID-dk5u:xMEP 0@MWC  "(8costate  B@oPHqAttribute VB_Name = "CoState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cosEnd| \5>      !"#$%&'()*+,./0123456789:;=>?@ABCDEFGHIJLMNOPRSTUVWXYZ[]^_abceghijklmnopqrstuvwxyz{|}~xME(<<< <h  Xat%"  .@Pp &x  (((P X h]@'If document is protected, Unprotect it.g9 z! cladd87 zB@~ FokPerform Spelling/Grammar check. ~(  z! !( !B@  ReProtect the document. z! cladd87@ l zB@koAttribute VB_Name = "Module1" Sub FormsSpellCheck2() Dim x As wdNo Then  9ZPassword:="c@ladd87E nd If'P(erf ing/Gramma8r clK.Op2tBs.vWi thFalse EachIn JsZx.Range.iof>$;;5AlwaysSuggest :=Tru; Next: 'Re the=&EW, N oRese&, o:=wdAllowOnlyAbAAedkw5w:xMEP 0@MWC  " <H hx8 This saves as a form without resetting the form fields.h@l B@>oAttribute VB_Name = "NoReset" Public Sub MAIN() Rem This saves a form without rztin g the4fields. WordBasic.ToolsProtectDocument ~:=1, Ty pe:=2End dk5i:xMEP 0@MWC  "(8otherid  B@oPHsAttribute VB_Name = "OtherID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=$"oidEnd| dk5k:xMESection<__SRP_0d__SRP_1KZ__SRP_2QP 0@MWC  "(8Section  B@oPHjAttribute VB_Name = "Section" Public Sub MAIN() WordBasic.WW7_EditGoTo Desti$nar:=End| rU   K*s@@<<::==99rU~~~~~~~~~~~~~~~~~~J !D5P  B Ia  q%1Y!Iq 1Y!Aa!Aa!9Qi !9QA iiA  a  A  h  9 a a  Qi %1 A !  TemplateProject ThisDocumentSuperPhoneNumberUnitGranteeFirstNameWorkerExtensionGranteeLastNameGranteeClientIDGranteeAddress1AddChildInfoRowWorkerAreaCodeSupervisorNameSuperExtentionAddSvcReferral SvcRefHeading SuperAreaCode GranteeCareof CoSuppaddress CoPhoneNumber ClearCaseInfoCounty NewParagraph GranteeState countynumber WorkerPhone GranteeCity CoExtension ClientState WorkerName GranteeZip CountyName CoAreaCode ClientCity CaseNumber WorkerFax RemoveRow lastname2 FirstName CoAddress ClientZipRowBreakLastNameDistrictCaseInfoAddress1SectionOtherIDNoResetCoStateCorrectAddRowsWorkerCoZipHiddenVBACoCityCareOfFaxACDate1ChildrenInTheHomeAdultsInTheHomeAddIdentInfoAutoAutoSaveChildAvailableDatesofContacts DeleteRowNewMacroF /C:\PROGRA~1\COMMON~1\MICROS~1\VBA\VBA6\VBE6.DLL  0 F5C:\Program Files\Microsoft Office\Office10\MSWORD.OLBWord  ) @0FC:\WINNT\System32\StdOle2.tlbstdole  P.E .`M C:\WINDOWS\System32\FM20.DLLMSForms y y  `3]6D0d 0C:\DOCUME~1\bushd2\LOCALS~1\Temp\VBE\MSForms.exd Y y  pL-[DR 2C:\Program Files\Microsoft Office\Office\MSO97.DLLOffice IqAutoNewAutoOpenFormsSpellCheck2 checkSections CheckSpelling  F F)Qb F` F F Fp F F)k F `There is already ONE Adult in the Home section.    hHow many ADDITIONAL Adults are needed for this form?  TExample: {Total adults being reported = 3} j { Minus existing = 1} j { Enter additional = 2} *CANCEL or ESC if none .IDENTIFYING INFORMATION In Case InfoVBE6.DLL ZYou MUST Save This Document Before Continuing 2Select Save In Folder and HEnter File Name in SaveAs Dialog Box 0 u F adultsinthehomeAutoTextEntries WhereRichText Insert AdultsHomefĤIx8< Error ` T   ( S H vThere is already ONE Child Available for Adoption section.  lHow many ADDITIONAL Children are needed for this form?  Z Example: {Total children being reported = 3} p { Minus existing = 1} p { Enter additional = 2} ChildAvailable Children `There is already ONE Child in the Home section. "ChildrenintheHome ChildHomeMAINModule1L trU~|  yQAi0  (Ilptx$ 8x (t Hp pl 4)xtplx$ x xx$ 8Qxhxh Qxd d cdchx$ Qx` ` c`0hd`xtpl0  0  0 X  WrU $`$`$`$`$!`n__SRP_3\__SRP_4`__SRP_5dg__SRP_6#frU~| yQT x$ 4x x $ xkrU $`nrU~|   y IyQ !AI1YYqdK h  8      x  X 'H'h''(:N*#x*F:XhH8(:::xhXH:8( F(8/x60hH8(xhXH(hH:X h hH 8 8(:     : `1$6hH8( 838:X ]3$ 4 ):XNhh$ 4 5h8((Xp7'8(Hh$ < 6hH8$ < \$  |o$ < QoH%c%:X%h$ 4 Xh>()6hH(2(Hh$ < 6hHF:NHH'('8h$ < )6hH8( ,5:XNhhcH$ 4 6hH$  lf"&'8'H'h$MX@ 6hH8 mx  ,  '('8l#*#*FH0>xFh 2)6hH8( <$8$xhH8(xhXH(hH(krU $`nrU~|   !y IyQ !A"1#Yq__SRP_7g__SRP_8 "__SRP_9g__SRP_a!%dK h  8      x  X 'H'h''(:N*#x*F:XhH8(:::xhXH:8( F(8/x60hH8(xhXH(hH:X h hH 8 8(:     : `1$6hH8( 838:X ]3$ 4 ):XNhh$ 4 5h8((Xp7'8(Hh$ < 6hH8$ < \$  |o$ < QoH%c%:X%h$ 4 Xh>()6hH(2(Hh$ < 6hHF:NHH'('8h$ < )6hH8( ,5:XNhhcH$ 4 6hH$  lf"&'8'H'h$MX@ 6hH8 mx  ,  '('8l#*#*FH0>xFh 2)6hH8( <$8$xhH8(xhXH(hH(krU $`nrU~|    $ !y IyQ !A$19%YqdK h  8      x  X 'H'h''(:N*#x*F:XhH8(:::xhXH:8( F(8/x60hH8(xhXH(hH:X h hH 8 8(:     : `1$6hH8( 838:X ]3$ 4 ):XNhh$ 4 5h8((Xp7'8(Hh$ < 6hH8$ < \$  |o$ < QoH%c%:X%h$ 4 Xh>()6hH(2(Hh$ < 6hHF:NHH'('8h$ < )6hH8( ,5:XNhhcH$ 4 6hH$  lf"&'8'H'h$MX@ 6hH8 mx  ,  '('8l#*#*FH0>xFh 2)6hH8( <$8$xhH8(xhXH(hH(krU $ `nrU~|  krU $ __SRP_bg__SRP_c$&T__SRP_dgAddress17`ndk5m:xMEP 0@MWC  "(8Address1  B@oPHnAttribute VB_Name = "Address1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:"= End~ AutoSavePCaseInfo(*!DistrictLastName)-5&xME(6 LLP `xxkp%0zH@x H@MWC $*\Rffff*1844c6103d*\R1*#17b*\R1*#c1*\R1*#c6" & 0@ P Macro created 11/30/04 by Andi zB@|o80yAttribute VB_Name = "AutoSave" Sub 8() ' Macro created 11/30/04 by Andi ActiveDocument. End dk5a:    1 &!"#$%'0()*+,-./29D345678:B;<=>?@ACKEwFGHIJLsMNOPQtSTUVWXYZ[\]^_`abcdefghijklmnopqr~uvxyz{|}[5o:xME @`bbEnter Personal InformationTemplateProject.CaseInfo.MAINx@ B@2PP:PPPPE PPP@ e` mHMWC c " (08@HPX `"& (&0(X&(&&& $H Np*,* .P*,44.P   <FHXFJF8HLLHh 2 & FHHFJ Fp H L LP H " B DX B F B0 Dx H H DP " 6 : B8>6:N8NB 4 X` p ]]]]]]]]0]H]`]xOPEN FCTPSA TOOLBAR B@ FCTPSA Tools B@:DEFINE DIALOG BOXF,CaseInfo B@  YourFCCNo B@8 YourFCCN B@1P  YourFCWLNo B@i YourFCWN B@  YourPSCNo B@ YourPSCN B@KfYourHAL B@fYourHAF B@fYourDC B@k  0Enter the following information about this case. B@d# FC Case No.: B@d; FC Case Name: B@dR FC Load No.: B@dk FC Worker Name: B@d PS Case No.: B@d PS Case Name: B@d Household Ass'd Last: B@d Household Ass'd First: B@d Date Completed: B@d,X B@ B@]F !!.6GET USER INFO FROM INI FILE AND PUT IT INTO DIALOG BOXUserInfoFCCaseNoC:\Windows\CaseInfo.ini %  ( UserInfo FCCaseNameC:\Windows\CaseInfo.ini %  (UserInfoFCLoadNoC:\Windows\CaseInfo.ini %  (UserInfo FCWorkerNameC:\Windows\CaseInfo.ini %  (UserInfoPSCaseNoC:\Windows\CaseInfo.ini %  (UserInfo PSCaseNameC:\Windows\CaseInfo.ini %  (UserInfo HouseholdLastC:\Windows\CaseInfo.ini %  (UserInfoHouseholdFirstC:\Windows\CaseInfo.ini %  (UserInfo DCompletedC:\Windows\CaseInfo.ini %  (,DISPLAY DIALOG BOX AND RESPOND TO USER INPUT  !%'  OK BUTTONWRITE NEW USER INFO IN INI FILEUserInfoFCCaseNo ! C:\Windows\CaseInfo.ini B@ UserInfo FCCaseName !C:\Windows\CaseInfo.ini B@ UserInfoFCLoadNo !C:\Windows\CaseInfo.ini B@ UserInfo FCWorkerName !C:\Windows\CaseInfo.ini B@ UserInfoPSCaseNo !C:\Windows\CaseInfo.ini B@ UserInfo PSCaseName !C:\Windows\CaseInfo.ini B@ UserInfo HouseholdLast !C:\Windows\CaseInfo.ini B@ UserInfoHouseholdFirst !C:\Windows\CaseInfo.ini B@ UserInfo DCompleted !C:\Windows\CaseInfo.ini B@ Get user info from INI fileUserInfoFCCaseNoC:\Windows\CaseInfo.ini % ' UserInfo FCCaseNameC:\Windows\CaseInfo.ini % ' UserInfoFCLoadNoC:\Windows\CaseInfo.ini % ' UserInfo FCWorkerNameC:\Windows\CaseInfo.ini % ' UserInfoPSCaseNoC:\Windows\CaseInfo.ini % ' UserInfo PSCaseNameC:\Windows\CaseInfo.ini % ' UserInfo HouseholdLastC:\Windows\CaseInfo.ini % ' UserInfoHouseholdFirstC:\Windows\CaseInfo.ini % ' UserInfo DCompletedC:\Windows\CaseInfo.ini % '  Update Form with user infoFCCASENO %"GFCCASENO  B@$j FCCASENAME %"G FCCASENAME  B@$jFCWORKERLOADNO %"GFCWORKERLOADNO  B@$j FCWORKERNAME %"G FCWORKERNAME  B@$jPSCASENO %"GPSCASENO  B@$j PSCASENAME %"G PSCASENAME  B@$jHOUSEHOLDASSESSEDLST %"GHOUSEHOLDASSESSEDLST  B@$jHOUSEHOLDASSESSEDFST %"GHOUSEHOLDASSESSEDFST  B@$j DATECOMPLETED %"G DATECOMPLETED  B@$j. Update other Form Fields on Form & Exit Macrod B@&'kxophmAttribute VB_Name = "CaseInfo" Public Sub MAI`N() D.rDescriptionEnter Personal rma:zProcDataIInvoke_FuncITemplateA"ject..yLDim iRet  UserFCCNo$ I WL WNPS HALFDCSelU 'OPEN FCTPSA TOOLBAR WordBasic.ViewToolbars ColorButtons:=1, Large0, Tipc"':=";/s", Show+'DEFINE DIALOG BOXBeginDialog 582, 30 Ʌ 1Text@Box 15 3 265, 18, "Youdka 56,  8/ wW 7@ 10ˀ& N13]\ 5A  2AY1y510QO 24 F i24 $DC@ 4 1079` 4B3;c|the following info} about this c. 19K$,1 FC | No.:w5p!YLoad #Y^k{x 1` PS} ,5,3 1 93(Household AsHs'd`st2B;FirD`eted3IOKc26% 821 EndÏdlgA Oba: SHet I= GCurValues.! GET USER INF@O FROM I FILE AND PUT I@NTO .@G[GetPrivfileSng$]("\NoaC:\Windows\!.ini" p H?u $T???C5?u?oNCp`9Q9_er"\OON OOjS##2bdaDLastooegHAF???KϒGOOHDC??>DCoKCDISPLAYAbCRESPOCPCED * HHIf(x>P?If0-1 Then 'OK BUTTONWRITE NEWXLIN6LYTQH`zHeB,G~OJo<O e4:CN;&HM_R] GW % GEo k SGO"qrA GL >FFFDCr fromr?cqfD)dC:("UserInfo", "FC CaseNXC:\Windows\P.ini"p) N$ = WordBasic.[GetPrivateProfileString$]1amev"jWLNo5lLoad(ՆWjkerNkPSC5k)ց4#'5HALsHouseholdLastdHAF<HFirfDC3DCompleted5 ' Upd Form with @Er &iIfExistBook mark(AASENO") ThDen SetR`esult ,2 yo$_ G AME CC A WORKERLOAD N'f N?!@j#/]4# ?$_ "H HOUSEHOLDASSE@DLST^B_#AnF"F?!DATECOMPLET?@ABCDEFGHIKLMNOPQRSTUVWXZ[\]^_`abcdefgijklmnopqrstuvwxz{|}~MEP 0@MWC  "(8lastname  B@oPHsAttribute VB_Name = "LastX" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="lnEnd~ dkO5e:xMENewMacroRowBreak,.ClientZipCoAddress+3$T(7S5!xME0<<*6 L*LL*LLL*L<4<8<<< @`  ``k ` " % X` 8 8%` ` PX@%(~@x @t @p @l 8h `%XhdP` %8``,%h `XMWC $*\Rffff*1744c6103d*\R1*#74*\R1*#17b*\R1*#c1*\R1*#d0*\R1*#d2*\R1*#158*\R1*#159*\R1*#c0*\R1*#166h"  J &`    <8"@ H JP & I     (0 <8x"   . & 0HX (p( ( "  F VX b > X`*h        (8 " @ H P &p R  (08@H Xh p( D AutoOpen Macro to fit to page, turn toolbar on and show hidden text Macro recorded 09/26/05 by Comp  !!!( ( 59q(q  ~9q5CommandBars("Custom DHS-1926 Toolbar").Visible = True0Coo@D AutoOpen Macro to fit to page, turn toolbar on and show hidden textp Rec Macro recorded 09/26/05 by Comp  !!!( (LNK 59qq ~9q5CommandBars("Custom DHS-1926 Toolbar").Visible = Trueo]( If document is protected, Unprotect it. z! cladd87 zB@~kPerform Spelling/Grammar check. ~(  z! !( !B@   ReProtect the document. z! cladd87@ l zB@k(!Application.ScreenUpdating = Trueo?WARNING: ANY USE BY YOU OF THE CODE PROVIDED IN THIS EXAMPLE ISPAT YOUR OWN RISK. Microsoft provides this macro code "as is" without warranty of[any kind, either express or implied, including but not limited to the implied warranties of8merchantability and/or fitness for a particular purpose.] ]@Check for Spelling Now? $4'  A@ (  z!5 ! !B@k A@k (oX CheckSpelling MacroG: Macro recorded 09/30/05 by Comp z! k0"Do you wish to check spelling now?    Check Spelling$4'  dk ~! zB@dx zB@k`Xcladd87@ l zB@o( cladd87 zB@~Attribute VB_Name = "NewMacro" Sub AutoH() '< Open  t o fit page, turnolbar on and show hiddj0textzrecorded 09/26/05 by Comp" ActiveWindow. Pane.View.Zoom.PwF= wd BestApplication.DisplayStatusB= TrueWith 7 B 9 .SmzHlTl'E~)OpKs*.Printa )FalsQ ' mds("Custom DHS-1926 To")[siblN"s?x?x?x?xb?x?x=xFormsSpellCheck2z Dim x As FieldrIf document is protected, Un it. #eDVblType <>qNoP# Then+ ' Passw:="cladd 87`UIf Perf ing/Gramzmxc 6-.b!me@ti Each In~"Csx.Range.of`& Alwa@ysSugg:=co Nx' Re# thNe&/+Aywd+n t2 p+, No Resetc, 7:=wdAllowOnly 0A(ScreenUpdng"4S@IAs"WARNING: ANY USE BY YOU OF THE CODE PROVIDED INIS EXAMP LE ISAATR OWN RISK. MisoftWvid,es*Xm code "as[" w`out warranty o@L'any "k@, eer express or im!aincludA@ not limid8$e iA merch abili@{/ na @[ a particulZpurposeA_vmyd(wDHyLong x0MsgBox`c ! RNow?", vbYesNoP}(  |7 Baea;+P 0@MWC  "JXh00"$  B@o Attribute VB_Name = "RowBreak" Public Sub MAIN() WordBasic.Table\Height RulerStyle:="0", LineSpacingq6:=0 &J$eftIndent5 + Chr(34), Alignm9AllowmSpli+@1 End dk5g:xMEP 0@MWC  "(8 clientZip  B@oPHqAttribute VB_Name = "ClientZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cEnd dk5Y:xMEP 0@MWC  "(8 coaddress  B@oPHsAttribute VB_Name = "CoAddress" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination@:="coaEnd dk[5vxMEDeleteRow3FirstName02Jlastname2YRemoveRow15h P  0@MWC  "  "  H"X@  DeleteRow MacroAdded 8/23/05 - Andi Putman B@ "  B@ !B@ocladd87 zB@~#V,cladd87@ l zB@Wreprotect document"Attribute VB_Name = "DeleteRow" Sub <() '< Macro"Added 8/23/05 - Andi PutmanbActiveDocument.Unprotect Password:="clapdd87r~0oxn.S MoveUp Unit:=wdLine, Coun1, ExternPwd :IsR. PI, NoRese0Tru6Type=AllowOnlyFormFields 're ndxEnd dk5[:xMEP 0@MWC  "(8 firstname  B@oPHtAttribute VB_Name = "First`" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="fnEnd dk5]:xMEP 0@MWC  "(8 LastName2  B@oPHtAttribute VB_Name = "lastnX2" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="LEnd dks5_:xMEP 0@MWC  "   (8Xh B@0 B@L B@@l B@>o Attribute VB_Name = "RemoveRow" Public Sub MAIN() WordBasic.ToolsUnprotectDocument BableS\el<2Dt oYP W NoReset:=1, Type:=2 End dk5Q:xMEP WorkerFaxyCaseNumber46ClientCityCoAreaCode/G0@MWC  "(8 WorkerFax  B@oPHmAttribute VB_Name = "WorkerFax" Public Sub MA@IN() dBasic.WW7_EditGoTo Destination:= End dk5S:xMEP 0@MWC  "(8 casenumber  B@oPHuAttribute VB_Name = "CaseNumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="cnEnd dk5U:xMEP 0@MWC  "(8 clientcity  B@oPHuAttribute VB_Name = "ClientCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="ccEnd dk5W:xMEP 0@MWC  "(8 coareacode  B@oPHxAttribute VB_Name = "CoAreaCode" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="coa"cEnd dk5I:xCountyNameGranteeZip8:WorkerNameClientState9=MEP 0@MWC  "(8 countyname  B@oPHuAttribute VB_Name = "Countyh" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=4"cnEnd dk5K:xMEP 0@MWC  "(8 GranteeZip  B@oPHpAttribute VB_Name = "GranteeZip" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End dk5M:xMEP 0@MWC  "(8 workername  B@oPHtAttribute VB_Name = "Workerh" Public Sub MAIN() dBasic.WW7_EditGoTo Destination:="wnEnd dk5O:xMEP 0@MWC  "(8 clientstate  B@oPHvAttribute VB_Name = "ClientState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinati@on:="csEnd dk5A:xMEP CoExtensionGranteeCity<>WorkerPhonecountynumber;C0@MWC  "(8 coextension  B@oPHtAttribute VB_Name = "CoExtension" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinatr@:="coeEnd       !"#$%&'()*+,./0123456789:;=>?@ABCDEFGHIJKLMOPQRSTUVWXYZ[\]^`abcdefghijklmnopqrstvwxyz{|}~dk5C:xMEP 0@MWC  "(8 GranteeCity  B@oPHqAttribute VB_Name = "GranteeCity" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:= End dk5E:xMEP 0@MWC  "(8 workerphone  B@oPHuAttribute VB_Name = "WorkerPhone" Public Sub MAIN() dBasic.WW7_EditGoTo DestinationP:="wpEnd dk5G:xMEP 0@MWC  "(8 Countynumber  B@oPHtAttribute VB_Name = "countynumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="C End dk55xGranteeState-NewParagraph@B<fThisDocumentN_VBA_PROJECTAER@MEP 0@MWC  "(8 GranteeState  B@oPHrAttribute VB_Name = "GranteeState" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinat ion:= End dk55xMEP 0@MWC  " (@`px B@4 B@0d $ B@:in@l B@>din B@^4oŰAttribute VB_Name = "NewParagraph" Public Sub MAIN() WordBasic.ScreenUpdating 0 >ToolsUnprotectDo@cument Insert Chr(13[?P = NoReset:=1, Type:=2 QCharRight 1 End W55#xME (SLSS<N0{00020906-0000-0000-C000-000000000046}@(%H@0MWC  xAttribute VB_Name = "ThisDocument" Bas0{00020P906-0C$0046} |GlobalSpacFalse dCreatablPredeclaIdTru BExposeTemplateDerivBustomi&zD2 dk55as  *\G{000204EF-0000-0000-C000-000000000046}#4.0#9#C:\Program Files\Common Files\Microsoft Shared\VBA\VBA6\VBE6.DLL#Visual Basic For Applications*\G{00020905-0000-0000-C000-000000000046}#8.2#0#C:\Program Files\Microsoft Office\Office10\MSWORD.OLB#Microsoft Word 10.0 Object Library*\G{00020430-0000-0000-C000-000000000046}#2.0#0#C:\WINDOWS\system32\stdole2.tlb#OLE Automation*\G{0D452EE1-E08F-101A-852E-02608C4D0BB4}#2.0#0#C:\WINDOWS\system32\FM20.DLL#Microsoft Forms 2.0 Object Library *\G{04B0CAD1-BBA2-459B-AE97-82ED402A8A87}#2.0#0#C:\DOCUME~1\MARTIN~2\LOCALS~1\Temp\VBE\MSForms.exd#Microsoft Forms 2.0 Object Library.E .`M &*\G{2DF8D04C-5BFA-101B-BDE5-00AA0044DE52}#2.2#0#C:\Program Files\Common Files\Microsoft Shared\Office10\MSO.DLL#Microsoft Office 8.0 Object LibraryB  MWC +)(/.-,#"! 9=%$A8:?2@<;65>5BThisDocument0@44c6103dThisDocument5] SuperPhoneNumber0A44c6103d SuperPhoneNumber5-Unit0B44c6103d"Unit :0 GranteeFirstName0C44c6103d$ GranteeFirstName5H-WorkerExtension0D44c6103d&WorkerExtension5`-GranteeLastName0E44c6103d(GranteeLastName5x-GranteeClientID0F44c6103d*GranteeClientID5-GranteeAddress10G44c6103d,GranteeAddress15-AddChildInfoRow1c4b2b7fde.AddChildInfoRow5*WorkerAreaCode0I44c6103dBWorkerAreaCode5%SupervisorName0J44c6103dDSupervisorName5%SuperExtention0K44c6103dFSuperExtention5%AddSvcReferral0L44c6103dHAddSvcReferral5 SvcRefHeading0M44c6103dJSvcRefHeading58 SuperAreaCode0N44c6103ddSuperAreaCode5P%GranteeCareof0O44c6103dfGranteeCareof5h%CoSuppaddress0P44c6103dhCoSuppaddress5%CoPhoneNumber0Q44c6103djCoPhoneNumber5%ClearCaseInfo0R44c6103dlClearCaseInfo5NewParagraph0S44c6103dNewParagraph5GranteeState0T44c6103dGranteeState5%countynumber0U44c6103dcountynumberG:%WorkerPhone0V44c6103dWorkerPhoneE:%GranteeCity0W44c6103dGranteeCityC:(%CoExtension0X44c6103dCoExtensionA:@%ClientState0Y44c6103dClientStateO:X%WorkerName0Z44c6103dWorkerNameM:p%GranteeZip0[44c6103dGranteeZipK:%CountyName0]44c6103dCountyNameI:%CoAreaCode0^44c6103dCoAreaCodeW:%ClientCity0_44c6103dClientCityU:%CaseNumber0`44c6103dCaseNumberS:%WorkerFax0a44c6103dWorkerFaxQ:%RemoveRow0b44c6103dRemoveRow_:ylastname20c44c6103dlastname2]:0%FirstName0d44c6103dFirstName[:H%CoAddress0e44c6103dCoAddressY:`%ClientZip0f44c6103dClientZipg:x%RowBreak0g44c6103dRowBreake:ULastName0h44c6103dLastNamec:%District0i44c6103dDistricta:% CaseInfo0j44c6103dCaseInfoo:a Address10k44c6103d(Address1m:% Section0l44c6103d*Sectionk:% OtherID0m44c6103d,OtherIDi: % NoReset0n44c6103d@NoResetw:8}CoState0o44c6103d.CoStateu:P%Correct0p44c6103d0Corrects:hAddRows0q44c6103d:AddRowsq: Worker0r44c6103d< Worker: CoZip0s44c6103d> CoZip: Hidden0t44c6103d@ Hidden{: County0u44c6103db Countyy: CoCity0v44c6103dd CoCity: CareOf0w44c6103df CareOf: FaxAC0x44c6103dh FaxAC:( Date10y44c6103dj Date1:@"ChildrenInTheHome0:4b02a90al"ChildrenInTheHomecX'AdultsInTheHome1944c610c7AdultsInTheHomep AddIdentInfoAuto1144c6103d AddIdentInfoAuto!Nu 7AutoSave1844c6103dAutoSave&0ChildAvailable084b02a8b5ChildAvailable?&DatesofContacts1444c6103dDatesofContactsQ 4DeleteRow1544c6103dDeleteRowva3NewMacro1744c6103dNewMacro!Y1Module11e4b2b7ff5Module1> b@@0X Xh8`(Hxp0 (8@hPxHפw09/Aߡ]"m)L1{[òNN3@v#^-}bԣ/M3}1љ7#nN-JLuΌItR]$}בBf[PK說FUB~gO&A OH`V&hʕIO*E4;. gj&NFmV )U}RDSlWÈ@2TVl_J ^/@fiDD?Ͳ<Fx×G{FS2J9O=hqiLEAoH&MzMuj.AyWHɬ<2[hC_6%Ȁ]O$Kr^%ROwGNϬ|&pCR "`q[Moؕu/M4N&hH@4-J|H>f GͻGOחNp GM7^POƱIW-hFp$DGLMm 9Oo;e<wB5'N`gڏOQD628xF7bwHa81FAYY<]^B4y<"=#>$?%@&A?B@C'D(J)KA)*L++t u/.z{1/|-,};0~A3#%'=1?2)+-/[ ClearCaseInfo_^CoPhoneNumberDFuCoSuppaddressGranteeCareof?OxMEP 0@MWC  "&  p c:\windows\r caseinfo.initvxz|~d B@n10c:\windows\caseinfo.ini B@eoH@EAttribute VB_Name = "ClearCaseInfo" Public Sub MAIN() WordBasic.File@Find Slch:=" ",! Path c:\wJows\4Jceie.ini0ubDir:=0, Title6Autho" Keywysject Option=`MatchKex#ternDateSavedFrom# LToByCoAttribute VB_Name = "SvcRefHeading" Public Sub MAIN() WordBasic.ToolsUnprotectDocu@ment Ba@bleSel9__!h|!10o????"t?, 'Addatructio n ,!Down T!Oas ShiftB:=2Is͡RightN" Merge I J 9l B`erJ JUEd1Ӎ c._ KH1/gQ~wτsP NoReseA , Typ#@REndA 55xME @x      !"#$%&'()*+,./0123456789:;=>?@ABCDEFGHIJKLMNOPQRSTUVWXYZ\]^_`abcdefghiklmnopqrstuvwxz{|}~-Adds a row and fields for A. Service Referralrms#TemplateProject.AddSvcReferral.MAIN)PMWC  "  2( `2p 2 2 82H 2 2 2  X2h 4 40@`p B@00/P B@2SvcRefF168: B@4RS B@2L$ksSvcRefF268: B@48\ B@2ltISvcRefF368: B@4US B@2SvcRefF468: B@4 B@2SvcRefF568: B@4 B@2SvcReff668: B@4 B@2SvcRefF768: B@4 B@2SvcRefF868: B@4 B@2SvcRefF968: B@4 B@2 SvcRefF1068: B@4 B@2 SvcRefF1168: B@4- B@<@l B@>oAttribute VB_Name = "AddSvcReferral" Public Sub MAIN(X) ".~Descriptions a row and fields for A. Ser`vice ePProcData\Invoke_Func\Template"ject. . WordBasic.ToolsU nprot2Document NextCell WW7_EditAutoT" :="F1", Cont :=1, InsertAs:=0 <22a23?YmK4?5?f6?_27?8 u_X.?9 1^0 ~t CharLeft p45 i @NoRese, Type:=2 E dk55( 5?xME6 LLLLL  `L660x%@pzPx @h @X @H @8 @( @ @@ @ @ @ @ @ @ x@ 0p @x @h @X @H @8 @( @ @ @  @  @  @ P @x h @X H 8 @( X$@v @  @ hx/ 999iiiX ( @ 4( @ P@MWC $*\Rffff*084b02a8b5*\R0*#e*\R0*#f*\R0*#14*\R1*#17b*\R1*#c1*\R1*#c6*\R1*#1e*\R1*#129*\R1*#c0*\R1*#1f*\R1*#91*\R0*#13*\R0*#1a*\R0*#19*\R0*#16"  X(   X   0 8H P  X h7  @o2"F  H X` h@p x &$&.8m68p x  ChildAvailable MacroR Macro recorded 01/11/01 by Program Area, modify 2/1/05 Diane Bush to add childrennp;There is already ONE Child Available for Adoption section. r r6How many ADDITIONAL Children are needed for this form? $ $ - Example: {Total children being reported = 3} $ 8 { Minus existing = 1} $ 8 { Enter additional = 2} $ $ CANCEL or ESC if none IDENTIFYING INFORMATION$p'P`-You MUST Save This Document Before Continuing $ $ Select Save In Folder and $ $ $Enter File Name in SaveAs Dialog Box ' t Define prompt P vxX P0ex@d8 zB@|  P " B@X B@ (  !ChildAvailable z!%B@: " B@ Children B@ k|x|n fsave file cancelled t A@4 #return to point of error in routined@ ! Error ! In Case InfoA@4+Reprotect Document and exit sub after errorkXoPHcladd87 zB@~cladd87@ l zB@[reprotect document״Attribute VB_Name = "ChildAvailable" Sub P()  ' T Macro. recorded 01/11/01 by Program Area, modify 2/5 Diane Bush to@ add crenT On Error GoTo HandlenumrowsInputBox("There is almdy ONE  f(Adoption sec. " & vbCr"How many ADDITIONA&L&O a4nefev(th:m?" +r(10)" Example: {Totalu beingport!= 3}"" { Minus exist'= 10#EnterbiE@)= 2 ChE7"CANCEL @TESC if none", "IDENTIFYING INFORMAAP 0@mpt$@o"You MUST Save TRDocume nt BeTe hCon4u@5VWS elrIn Fold1ndV C: File Bin BAslog 'Defi@pro@, AZCI;cmdCancel@0 ExitH2Else"0"&AAveJN.O Un.tAAGPassw@t:="clm87A F8i@2Ekn1 Step -1#,g.MoAwn Unit:P=wdL$, 5unSplit&T ApcaboDisplay AutoC`,le teTip!{TruekachedTe jateB.Text:r ies(").Insert _K W:=gRange, Ridcha :=DMCharac`fw@Wha$Bookmar|k,O11N  i+@,>SuperExtentionSupervisorNameLNWorkerAreaCode-AddChildInfoRow KS<xMEP 0@MWC  " (8superextension  B@oPH|Attribute VB_Name = "SuperExtention" Public Sub MAIN() WordBasic.WW7_EditGoTo DestinBar:="sesEnd dk55xMEP 0@MWC  " (8supervisorname  B@oPH{Attribute VB_Name = "Supervisor" Public Sub MAIN() WordBasic.WW7_EditGoTo Destinati@on:="snCEnd dk55xMEP 0@MWC  " (8workerareacode  B@oPH|Attribute VB_Name = "WorkerAreaCode" Public Sub MAIN() dBasic.WW7_EditGoTo Destination:="wacEnd ~55xME(6 << < `0.x%P@MWC $*\Rffff*1c4b2b7fde "  4( `4p 4 4 84H 4 4 @P B@0 B@2 ChildInfo168: B@4 B@2 ChildInfo268: B@48\ B@2ltI ChildInfo368: B@4US B@2 ChildInfo468: B@4 B@2 ChildInfo568: B@4 B@2 ChildInfo668: B@4 B@2 ChildInfo768: B@4 B@<@l B@>oAttribute VB_Name = "AddChildInfoRow" Public Sub MAIN () WordBasic.ToolsUnprotectDocument BNextCell &WW7_EditAutoT" :="1"@, Cont:=0, InsertAs :=1U>f2c33c34c3567CharLeft( 30RP N@oReset, Type:=2 EndA dk'55xMEAdultsInTheHome DatesofContacts PRGranteeAddress1 [GranteeClientID QUj( 5xME6 LLLLL  `L550x%@pzPx W@h @x@X @H X@8 @( o@ ح@@ X@ `@ @ XX@ Pj@ @ x@ oP0p @x r @h t @X er@H 3@8 @( @ @ @ pper unty@ revi @  @ paddP SEnt@x lemeh e: @X umbeH 8 @( X$Co@v @ cr wr@ h\bFx/ \gorrX ( @ 4( @ P@MWC $*\Rffff*1944c610c7*\R0*#e*\R0*#f*\R0*#14*\R1*#17b*\R1*#c1*\R1*#c6*\R1*#1e*\R1*#129*\R1*#c0*\R1*#1f*\R1*#91*\R0*#13*\R0*#1a*\R0*#19*\R0*#15" X `h p          X 07H h xBo2$F  (0 8@x@ HP X&$`&.8m6@ H R Macro recorded 01/11/01 by Program Area, modify 2/1/05 Diane Bush to add childrenn0There is already ONE Adult in the Home section. r r4How many ADDITIONAL Adults are needed for this form? $ $ *Example: {Total adults being reported = 3} $ 5 { Minus existing = 1} $ 5 { Enter additional = 2} $ $ CANCEL or ESC if none IDENTIFYING INFORMATION$p'P-You MUST Save This Document Before Continuing $ $ Select Save In Folder and $ $ $Enter File Name in SaveAs Dialog Box ' t Define prompt P vx` P0exHd@ zB@|  P " B@ B@ (  !adultsinthehome z!%B@: " B@  AdultsHome B@ k|(x |n fsave file cancelled t A@4 #return to point of error in routined ! Error ! In Case InfoA@4+Reprotect Document and exit sub after errork(o cladd87 zB@~cladd87@ l zB@[reprotect documentAttribute VB_Name = "AdultsInTheHome" Sub T() ' Macro recorded 01/11/01 by Program Area, mod@ify 2/<5 Diane Bush to add childrenT On Error GoTo Hand letnumrowsInpu@tBox("re is alm@dy ONE in the  section. " & vbCr"How many ADDITIONALzD a-neepfJth4m?" + Chr(10)"Example: {Totalp beingport!= 3} !" {Minus exist&= 1!Enteri@'= 25"CANCEL =ESC if none", "IDENTIFYING IN`FORMAM0Cmpt$i"You MUST Save TODocument BeRe Con3u4USeloIn Fol2d1ndV C:Fi8le BA Asalog 'Defipro@, ]CI;cmdCancel@0 Exi@tHere2Else"0"&KAveJ./ Un.tAG Passw:="cl878u Fqidk1 Step -1'#,dMoAwn Unit:=wdL$, 5un3SplitTable#ApcanDisplayAutoC`,leteTipax8Truk`ac hedTe iate.Text:ries("ad)jin{h).Insert _Wh2:=Range, Rich :=D MChar`oRese, TypeA8AllowOnlyAmFields 'reGdr A  E2?$`M41D98_ 'safEarciled MsgqƠp$,@cal@turnpo?` of e{r|ou$JApJ `.DescripRA ExdmT` or!Numb&@n Cas@e Infoi e" 'R(fב!t s af">+@,>dkK 5xMEP 880@MWC 9 "  ^(   P   ( 0@ H  P `(x  @  @ PX `@h px &.860h p  DatesofContact MacroHW Macro recorded 01/11/01 by Program Area, modify 2/1/05 Diane Bush to add contact datesnh.There is already ONE Date of Contact section. r r2How many ADDITIONAL Contacts needed for this form? $ $ - Example: {Total contacts being reported = 3} $ 9 { Minus existing = 1} $ 9 { Enter additional = 2} $ $ CANCEL or ESC if none IDENTIFYING INFORMATION$p'P-You MUST Save This Document Before Continuing $ $ Select Save In Folder and $ $ $Enter File Name in SaveAs Dialog Box ' t Define prompt P vx@ P0ex(d  zB@|  P DatesofContact B@ B@ (  !DatesofContact z!%B@: " B@ Dates B@ k|x|n fsave file cancelled t A@4 #return to point of error in routined( ! Error ! In Case InfoA@4+Reprotect Document and exit sub after errork ocladd87 zB@~cladd87@ l zB@[reprotect documentôAttribute VB_Name = "DatesofContacts" Sub \()`' , Macro ' recorded 01/11/01 by Program Area, modify 2/5 Diane Bush to add c dY On Error GoTo HandlenumrowsInputBox("There is alrdy ONBE of t section. " & vbCr"How many ADDI@TIONALsP neepfHth2m?" + Chr(10)" Example: {Totalos beingport= 3}"" {Minus@ exist(= 1#Enter`iAE)= 27"CANCEL @ESC if none", "IDENTIFYING INFORMAO0!mpt$k"You MUST @Save TRDocument Be@Ue\@75WSelrIn Fold1ndV AC:File inBAslog @'Defipro@, ^ CI;FcmdC ancel@0en©ExitH2CElse"0"&A!AtveJ.OC U n.tAGPassw:="cll87F8i@2eil1 Stepx -1# ,ebWhat:=wdBookmark>,)  SplitTable%pcabqDisplayAutoC.leteTip{Tru`achedTe l@.TextAEnd If /KL>:d)k#m?5oReseA, TypeA:Allo wOnlyBmFields 're%Id$t A  E2h$a@`O4198Q"a 'sfsc"kled Msgg`s r$,c+@,>aP 0@MWC  ""0@GranteeAddress1  B@&a&oH@uAttribute VB_Name = "GranteeAddress1" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End dk'55xMEP 0@MWC  ""0@GranteeClientID  B@&a&oH@uAttribute VB_Name = "GranteeClientID" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:=End dk'55xMEP GranteeLastName yWorkerExtension TWAddIdentInfoAuto"nGranteeFirstName"VX0@MWC  ""0@granteelastname  B@ioH@~Attribute VB_Name = "GranteeLast" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="glnEnd dk'55xMEP 0@MWC  ""0@workerextension  B@&a&oH@xAttribute VB_Name = "WorkerExtension" Public Sub MAIN() dBasic.WW7_EditGoTo DestinaBtr:="weEnd dk'55dko 5!NxMEP 880@MWC 8"   Z0   x (  @P Xh p  x   D($H p  @  &. 8(6`   AddIdentAuto MacroS Macro recorded 01/11/01 by Program Area, modify 1/27/05 Diane Bush to add childrenn`0There is already ONE Child in the Home section. r r6How many ADDITIONAL Children are needed for this form? $ $ 4 Example: {Total children being reported = 3} $ B { Minus existing = 1} $ B { Enter additional = 2} $ $ CANCEL or ESC if none IDENTIFYING INFORMATION$p'Pg-You MUST Save This Document Before Continuing $ $ Select Save In Folder and $ $ $Enter File Name in SaveAs Dialog Box ' t Define prompt P vxX P0ex@d8 zB@|  P " B@ B@ (  !childreninthehome z!%B@: " B@  ChildName B@ k|x|n fsave file cancelled t A@4 #return to point of error in routined8 ! Error ! In Case InfoA@4+Reprotect Document and exit sub after errorkpoh`cladd87 zB@~cladd87@ l zB@[reprotect documentAttribute VB_Name = "AddIdentInfoAuto" Sub X()  '0V Macro* recorded 01/11/01 by Program Area, modify 1/27/05 Diane Bush to add childrenU On Error GoTo Handle nu mrowsInputBox("There is alndy ONE CR in the Ho{section. " & vbCr"How many ADDITIONAL JD a.neeqfKth5m?" +r(10) " Example: {Totals beingport= 3} &!%{Minus@ exist,= 1:(EnterfiL@.= 2 Ch>"CANCEL FESC if none", "IDENTIFYING INFORMAW0 mpt$@s"You MUST Save TXDocum@ Be[e C4on7u7^Sel@yIn Fodld1ndV C:Fpile B@A Aslog 'Defi@pro@, ]CI;cmdCancoRese, Typea8AllowOnly AmFields 'reGdr A ǣ E2$ `N4198_ 'sfrciledq Msgrp$,`calC`turnpo? of e{rouDJapJ `.DescripRA ExdmT3ora!Numb &`n Case a7 e" 'R(t s af">+@,>axMEP 0@MWC  ""0@granteefirstname  B@61oH@Attribute VB_Name = "GranteeFirstL" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="g5fnEnd dk'55SuperPhoneNumber"YChildrenInTheHome$PROJECT[PROJECTwmxMEP 0@MWC  ""0@superphonenumber  B@oH@Attribute VB_Name = "SuperPhoneNumber" Public Sub MAIN() WordBasic.WW7_EditGoTo Destination:="spnEnd ID="{C28CF6E8-C205-44AB-8AEF-82C4D6753B0B}" Document=ThisDocument/&H00000000 Module=SuperPhoneNumber Module=GranteeFirstName Module=WorkerExtension Module=GranteeLastName Module=GranteeC( 5cxME6 LLLLL  l`L770lx%@pzPx @h @X @H @8 @( @ @@ @ @ @ X@ @ @ x@ p`0p p`@x p`@h p`@X p`@H @8 @( @ p`@ p`@ p` p`@ p` p`@ p`  p`@ p`P @x h p`@X H 8 p`@( p`X$p`@v @ p` p`@ hx/ p`X p`( @ p` 4p`( @ p`P@MWC $*\Rffff*0:4b02a90a*\R0*#e*\R0*#f*\R0*#14*\R1*#17b*\R1*#c1*\R1*#c6*\R1*#1e*\R1*#129*\R1*#c0*\R1*#1f*\R1*#91*\R0*#13*\R0*#1a*\R0*#19*\R0*#17"   X0   X   0 8H P  X h7  Do2$F( P `h p@x  &$&.8m6@x   ChidrenInTheHome MacroR Macro recorded 01/11/01 by Program Area, modify 2/1/05 Diane Bush to add childrennh0There is already ONE Child in the Home section. r r6How many ADDITIONAL Children are needed for this form? $ $ - Example: {Total children being reported = 3} $ 8 { Minus existing = 1} $ 8 { Enter additional = 2} $ $ CANCEL or ESC if none IDENTIFYING INFORMATION$p'P-You MUST Save This Document Before Continuing $ $ Select Save In Folder and $ $ $Enter File Name in SaveAs Dialog Box ' t Define prompt  P vxH P0ex0d( zB@|  P " B@P B@ (  !ChildrenintheHome z!%B@:0 " B@  ChildHome B@ <k|x|n fsave file cancelled t A@4 #return to point of error in routined( ! Error ! In Case InfoA@4+Reprotect Document and exit sub after errork0o( cladd87 zB@~cladd87@ l zB@[reprotect documentAttribute VB_Name = "ChildrenInTheHome" Sub \()8 '2 ` M0acro2 recorded 01/11/01 by Program Area, modify 2/5 Diane Bush to add cT On Error GoTo Handle nu mrowsInputBox("re is almdy ONE in the s section. " & vbCr"How many ADDITIONA&L a.neeqfKth5 m?" +r(10)" Example: { Totalp beingporBt= 3}"" { Minus exist'= 10#Ent4er_iE@)= 2ChE7"CA NCEL @ESC if none", "IDENTIFYING INFORMAKAP0 mpt$l"You MUST Save TRDocument BeATe Con4uc@5VWSelrI@n Fold1ndV C:File 'A Aslo g 'Def"ipro@, AZCI;Fcmd@Cancel@0enªExitH0ere2CElse"0"&A!AveJ./SC Un.tAGPasswr:="dcl`l87F8i@2i m1 Step -1# , fMoAwn Unit:=wdL$, 5un3SplitTab$le#ApcaboDisplay AutoC`,le teTipyTrukachedTe jate.!Text:ries("Ein`}B).Insert _CWh 3:=Range@, Rich :v=GD`M%Characf%1"AWha"%Bookmark,bO/1N iA=End If bI$K:#> lu>oRese, Typea8AllowOnly AmFiel@ds 'reGd7r A ģ E2$ ``!N4198_ '*sfrciled Msgrap$,`cal`turnpo? of e"{rouDJapJ `.DescrLipRA ExdmgTor!N(umb &`n Case Infoi e" 'R(ءt s@af">+@,> lientID Module=GranteeAddress1 Module=AddChildInfoRow Module=WorkerAreaCode Module=SupervisorName Module=SuperExtention Module=AddSvcReferral Module=SvcRefHeading Module=SuperAreaCode Module=GranteeCareof Module=CoSuppaddress Module=CoPhoneNumber Module=ClearCaseInfo Module=NewParagraph Module=GranteeState Module=countynumber Module=WorkerPhone Module=GranteeCity Module=CoExtension Module=ClientState Module=WorkerName Module=GranteeZip Module=CountyName Module=CoAreaCode Module=ClientCity Module=CaseNumber Module=WorkerFax Module=RemoveRow Module=lastname2 Module=FirstName Module=CoAddress Module=ClientZip Module=RowBreak Module=LastName Module=District Module=CaseInfo Module=Address1 Module=Section Module=OtherID Module=NoReset Module=CoState Module=Correct Module=AddRows Module=Worker Module=Hidden Module=County Module=CoCity Module=CareOf Module=FaxAC Module=Date1 Module=CoZip Module=Unit Module=ChildrenInTheHome Module=AdultsInTheHome Module=AddIdentInfoAuto Module=AutoSave Module=ChildAvailable Module=DatesofContacts Module=DeleteRow Module=NewMacro Module=Module1 Name="TemplateProject" HelpContextID="0" VersionCompatible32="393222000" CMG="F0F2FCFA00FA00FA00FA00" DPB="17151B06650A8D0B8D0B8D" GC="3E3C326F7EB1A4B2A4B25B" [Host Extender Info] &H00000001={3832D640-CF90-11CF-8E43-00A0C911005A};VBE;&H00000000 [Workspace] ThisDocument=0, 0, 0, 0, C SuperPhoneNumber=26, 26, 593, 475, GranteeFirstName=130, 130, 697, 579, WorkerExtension=182, 182, 749, 631, GranteeLastName=156, 156, 723, 605, GranteeClientID=104, 104, 671, 553, GranteeAddress1=26, 26, 593, 475, AddChildInfoRow=107, 77, 607, 435, WorkerAreaCode=156, 156, 723, 605, SupervisorName=52, 52, 619, 501, SuperExtention=0, 0, 567, 449, AddSvcReferral=44, 44, 630, 479, SvcRefHeading=78, 78, 645, 527, SuperAreaCode=208, 208, 775, 657, GranteeCareof=52, 52, 619, 501, CoSuppaddress=26, 26, 593, 475, CoPhoneNumber=182, 182, 749, 631, ClearCaseInfo=208, 208, 775, 657, NewParagraph=78, 78, 645, 527, GranteeState=182, 182, 749, 631, countynumber=104, 104, 671, 553, WorkerPhone=26, 26, 593, 475, GranteeCity=78, 78, 645, 527, CoExtension=156, 156, 723, 605, ClientState=26, 26, 593, 475, WorkerName=0, 0, 567, 449, GranteeZip=208, 208, 775, 657, CountyName=78, 78, 645, 527, CoAreaCode=104, 104, 671, 553, ClientCity=0, 0, 567, 449, CaseNumber=182, 182, 749, 631, WorkerFax=208, 208, 775, 657, RemoveRow=88, 88, 588, 420, lastname2=52, 52, 619, 501, FirstName=0, 0, 567, 449, CoAddress=78, 78, 645, 527, ClientZip=52, 52, 619, 501, RowBreak=156, 156, 723, 605, LastName=26, 26, 593, 475, District=182, 182, 749, 631, CaseInfo=156, 156, 723, 605, Address1=78, 78, 645, 527, Section=182, 182, 749, 631, OtherID=130, 130, 697, 579, NoReset=104, 104, 671, 553, CoState=0, 0, 567, 449, Correct=208, 208, 775, 657, AddRows=22, 22, 522, 354, Worker=130, 130, 697, 579, Hidden=0, 0, 567, 449, County=52, 52, 619, 501, CoCity=130, 130, 697, 579, CareOf=130, 130, 697, 579, FaxAC=208, 208, 775, 657, Date1=156, 156, 723, 605, CoZip=130, 130, 697, 579, Unit=104, 104, 671, 553, ChildrenInTheHome=44, 44, 533, 512, AdultsInTheHome=49, 8, 601, 467, AddIdentInfoAuto=-37, 8, 656, 467, AutoSave=104, 104, 671, 553, ChildAvailable=110, 110, 461, 463, DatesofContacts=132, 132, 483, 485, DeleteRow=154, 154, 654, 486, NewMacro=22, 22, 522, 354, Z Module1=0, 0, 0, 0, C      ThisDocumentThisDocumentSuperPhoneNumberSuperPhoneNumberGranteeFirstNameGranteeFirstNameWorkerExtensionWorkerExtensionGranteeLastNameGranteeLastNameGranteeClientIDGranteeClientIDGranteeAddress1GranteeAddress1AddChildInfoRowAddChildInfoRowWorkerAreaCodeWorkerAreaCodeSupervisorNameSupervisorNameSuperExtentionSuperExtentionAddSvcReferralAddSvcReferralSvcRefHeadingSvcRefHeadingSuperAreaCodeSuperAreaCodeGranteeCareofGranteeCareofCoSuppaddressCoSuppaddressCoPhoneNumberCoPhoneNumberClearCaseInfoClearCaseInfoNewParagraphNewParagraphGranteeStateGranteeStatecountynumbercountynumberWorkerPhoneWorkerPhoneGranteeCityGranteeCityCoExtensionCoExtensionClientStateClientStateWorkerNameWorkerNameGranteeZipGranteeZipCountyNameCountyNameCoAreaCodeCoAreaCodeClientCityClientCityCaseNumberCaseNumberWorkerFaxWorkerFaxRemoveRowRemoveRowlastname2lastname2FirstNameFirstNameCoAddressCoAddressClientZipClientZipRowBreakRowBreakLastNameLastNameDistrictDistrictCaseInfoCaseInfoAddress1Address1SectionSectionOtherIDOtherIDNoResetNoResetCoStateCoStateCorrectCorrectAddRowsAddRowsWorkerWorkerHiddenHiddenCountyCountyCoCityCoCityCareOfCareOfFaxACFaxACDate1Date1CoZipCoZipUnitUnitChildrenInTheHomeChildrenInTheHomeAdultsInTheHomeAdultsInTheHomeAddIdentInfoAutoAddIdentInfoAutoAutoSaveAutoSaveChildAvailableChildAvailableDatesofContactsDatesofContactsDeleteRowDeleteRowNewMacroNewMacroModule1Module1  FMicrosoft Word Document MSWordDocWord.Document.89q @ vZbjbj t|\#t|\#ПППППb@|$k,ذذذذذV.¶Ƹȸȸȸȸȸȸ$R9ПذذППذذ%ПذПذƸƸППVذ hH;0kППППП FORMTEXT        FORMTEXT       Adults NameDate of Birth FORMTEXT       FORMTEXT      Relationship to Applicant Include Parenting Responsibilities (if any), History of crime, CPS involvement, substance abuse, mental health problems. FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT       FORMTEXT       Child s NameDate of Birth FORMTEXT       FORMTEXT      Relationship to Applicant (birth, foster, guardianship, etc.) Include Educational status, special needs (if any) FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT xxxxxykel$IfGkd.$$If90!>+ ~ 4 9aGk$IfEkdF-$$If90!>+ ~ 4 9aGxxxxx yyzzzzz$z&z,z.zBzDzFzPzRzTzVzjzlzzz|z~zzzzzzzzzzzzzzz{{ {{ {"{,{.{0{ɾͰɥɚͰɏͰɊɊͰj4h=1U h=15j2h=1Uj2h=1Uj1h=1Ujh=1UmHnHuj0h=1Uh=1jh=1Uj/UhU'<B* phjUmHnHu jUjc.U2yz(z*z,zTz|zzz~ kd$If652kdU0$$If9>+0*4 9aGk$If4kdv/$$If9>+0*4 9aGzzzz{{0{X{rllk$If@kd3$$If90!>+ ~ 4 9l$IfCkd\3$$If940!>+ ~ 4 9f40{2{F{H{J{T{V{{:|>|@|T|V|X|b|d|f|h|j|l||||||||||||||||||||||}}}}}Ю~sjx:h=1Uj9h=1Uj8h=1Uj8h=1Ujh=15UmHnHuj:7h=15Ujh=15UjZ6h=1U h=15 h=1<jh=1UmHnHuj4h=1Uh=1jh=1U-X{Z{<|>|f|h|j||}JHF72kd6$$If94>+0*4 9f4k$If2kd5$$If94>+0*4 9f4l$IfBkdZ5$$If90!>+ ~ 4 9|||}(}P}x}}}} 4V~Ύk$IfDChA@?>=<;:98}}$}&}(}*}>}@}N}P}R}f}h}v}x}z}}}}}}}}}}}}}}}}}}~ "$246JLN嬡匇zj?h=15U h=15jh=15Ujh=1UUj=h=1Uj8=h=1UjP<h=1Uj;h=1Uj.;h=1Uh=1jh=1UmHnHujh=1U0    FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT       FORMTEXT       FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT     FORMTEXT     FORMTEXT      FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT        FORMTEXT             !"#$%&'()*+,-./0123456789:;<=NRTVXln|~ʎ̎ΎЎ  "$8:<@BDFZ\ڶڶڶڶڶzjDh=1UjCh=1U h=15jBh=1UjLBh=1UjAh=1Ujh=1UmHnHuj(Ah=1Ujw@h=1Ujh=1Uh=1jh=15Ujh=15UmHnHu0 "Dh0XʐQPONjLKJIHGFbXkd8C$$If94F >+      4 9f4\^dfhj~ΏЏҏ܏ޏ  ",.02FHJTVXZnpr|~jKh=1UjJh=1UjJh=1UjHh=1Uj|Gh=1UjFFh=1UjDh=1Uh=1jh=1UmHnHujh=1U7ƐȐʐ̐ 02@BDXZhjlƑȑ֑ؑڑjQh=1UjQh=1UjoPh=1UjOh=1UjhOh=1UjNh=1Uj&Nh=1Ujh=1UmHnHuj0Mh=1Uh=1jh=1UjLh=1U3Bjؑ(Jl0XZ`_^]\[edXWVUcSR&(*>@BFHJL`bjlnΒВޒ  ",.0ڹڮڣژڍڂjtWh=1UjVh=1UjVh=1UjUh=1Uj4Uh=1UjTh=1UjTh=1UjSh=1Uh=1jh=1UmHnHujh=1UjRh=1U302FHVZjXXh=1Uh=1jh=1U/ =!"#$%CompObjjAddress1 UppercasedEnter the Addressee's mail address (street address, PO Box, etc., where the mail will be delivered).$$IfG!vh5 5~ #v #v~ :V 95 5~ /  / / /  / 44 9aGjDDjD$$IfG!vh5 5~ #v #v~ :V 95 5~ /  / / / 44 9aGg$$IfG!vh50*#v0*:V 950*/  44 9aGvDText18c$$IfG!vh50*#v0*:V 950*/ 44 9aG2DCareOf UppercaseUEnter the Addressee's Supplemental Address (Example: Suite or Apartment Number, C/O)D CaseNumber Uppercase/Enter the Case Number (Example: V1234567A,B,C)jDDjD$$IfG!vh5 5~ #v #v~ :V 945 5~ / / /  44 9af4$$IfG!vh5 5~ #v #v~ :V 95 5~ /  /  / 44 9ajDDjD$$IfG!vh5 5~ #v #v~ :V 95 5~ /  / / 44 9ah$$IfG!vh50*#v0*:V 9450*/  44 9af4vDYText17h$$IfG!vh50*#v0*:V 9450*/ 44 9af4D ClientCity UppercaseEnter the Addressee's City.D ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation.D ClientZip UppercaseKEnter the Addressee's Zip Code (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond`CJOJQJ_HmH sH tH VOV CoState1?d8(OJQJ_HkHmH sH tH bOb CoSuppaddress1@d8(OJQJ_HkHmH sH tH \O\ CountyName1Ad8(OJQJ_HkHmH sH tH ^"^ CountyNumberBd8(OJQJ_HkHmH sH tH VO2V CoZip1Cdt CJOJQJ_HkHmH sH tH NOBN Date11 Dd`CJOJQJ_HmH sH tH XRX District1Ed8(OJQJ_HkHmH sH tH LObL FaxAC Fd`CJOJQJ_HmH sH tH VOrV FirstName1 Gd`CJOJQJ_HmH sH tH XOX FirstName21 Hd`CJOJQJ_HmH sH tH `O` GranteeAddress1 Id`CJOJQJ_HmH sH tH \O\ GranteeCareof Jd`CJOJQJ_HmH sH tH XOX GranteeCity Kd`CJOJQJ_HmH sH tH `O` GranteeClientID Ld`CJOJQJ_HmH sH tH hh GranteeFirstName1Md8(OJQJ_HkHmH sH tH fOf GranteeLastName1Nd8(OJQJ_HkHmH sH tH ZOZ GranteeState Od`CJOJQJ_HmH sH tH ZOZ GranteeZip Pd` CJOJQJ_HkHmH sH tH XOX LastName1Qd8(OJQJ_HkHmH sH tH ZO"Z LastName21Rd8(OJQJ_HkHmH sH tH VO2V OtherID1Sd8(OJQJ_HkHmH sH tH VBV Section1Td8(OJQJ_HkHmH sH tH ^OR^ SuperAreaCode1 Ud`CJOJQJ_HmH sH tH dObd SuperExtension1Vd8(OJQJ_HkHmH sH tH dOrd SuperPhoneNumber1 Wd`CJOJQJ_HmH sH tH dOd SupervisorName1Xd8(OJQJ_HkHmH sH tH PP Unit1Yd8(OJQJ_HkHmH sH tH TT Worker1Zd8(OJQJ_HkHmH sH tH `O` WorkerAreaCode1 [d`CJOJQJ_HmH sH tH fOf WorkerExtension1\d8(OJQJ_HkHmH sH tH XOX WorkerFax ]d` CJOJQJ_HkHmH sH tH \O\ WorkerName1^d8(OJQJ_HkHmH sH tH ZOZ WorkerPhone1 _d`CJOJQJ_HmH sH tH ^O^ WorkerTitle1 `d` CJOJQJ_HkHmH sH tH ^^ countynumber ad` CJOJQJ_HkHmH sH tH TO"T District2 bd`CJOJQJ_HmH sH tH RO2R Section2 cd`CJOJQJ_HmH sH tH LOBL Unit2 dd`CJOJQJ_HmH sH tH TORT Worker2 ed` CJOJQJ_HkHmH sH tH ^b^ Countynumber fd` CJOJQJ_HkHmH sH tH `r` Countynumber1 gd` CJOJQJ_HkHmH sH tH \O\ Countynumber2 hd`CJOJQJ_HmH sH tH POP ***** id` CJOJQJ_HkHmH sH tH dOd GranteeFirstName2 jd`CJOJQJ_HmH sH tH ZOZ User Input 10ptkd8(5CJOJQJuPOP Captions 8pt ld`CJOJQJu\\ Captions 10ptmd`(CJOJQJmH sH uBCklfg34@0d d@0d @0d @0d @0d ԓ@0d @0d @0d @0d D@0d @0 d a^@0d @0 d ^@0d @0d ^@0d @0d ^@0d @0d |CR@0d @0d 3*****Address1AdultsInTheHomeCareOf CaseNumberChildAvailableChildrenInTheHome ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddressCounty CountyName CountynumberCoZip Date1DatesofContactDistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZip LastName LastName2 OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerPhone WorkerTitle***** CaseNumber1 ClientZip1 CoAddress1CoCity1 CoExtension1CoState1CoSuppaddress1 CountyName1CoZip1GranteeLastName1 GranteeZip LastName1 LastName21OtherID1SuperExtension1SupervisorName1Worker2WorkerExtension1 WorkerFax WorkerName1 WorkerTitle1 Captions 8ptUser Input 10pt(*>h5IZn+?S,@Tey%6H\p \ "ELx0{}N\0Z *3@CFJLMOP~ v x vRNDZFGJDLrLLLLLLPxyzX{|Z  !)+,-./012456?ABDEKNZ  &COUWci "(*6<>JPR^d+15AGIUXZflnz&)+7=?KQS_egsy{$*,8>@LRT`ceqwy  #%146BFHTZ\hnp|FFFFTFFFFTFTFFTFTFFFFFFFFFFFFFFFFTFTFTFFFFFFFFFFFFFFFFFFFFFFFFFFFF2GranteeFirstNameAddress1Text18CareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddressCounty CountyName CountynumberCoZipdate1Text19Text20DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerPhone WorkerTitle+6J[o,@h|-AUfz&7I]q  !"#$%&'()*+,-./01')=HYm*>Rz+?Sdx$5G[o=1(4BCWkl*>Rfghu34?Sg{a0a0a0@ A4pxpzp|pUnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New5& zaTahoma"h0@?=1