Electronic DSHS Forms

The Electronic DSHS Forms page is a centralized repository where the public can find and download official forms for Washington Department of Social and Health Services programs.

You may download some DSHS forms. These are provided only if a DSHS program requests forms to be available electronically for public use. DSHS forms are available for electronic completion in different software; however, all DSHS forms below are available as Adobe Acrobat PDF files. This means you can open, view, and print each form. To open, view, and print PDF forms, you need to download the free Adobe Acrobat Reader.

We do our best to ensure the links below are accurate; but, if you find a link which does not work, please contact Forms and Records Management.

Number Form Name Form File
16-365 Transportation Services Monitoring Self-Assessment (WaCares Fund)
16-366 Personal Emergency Response System Monitoring Self-Assessment (WaCares Fund)
16-367 WA Cares Fund Monitoring Worksheet (WaCares Fund)
16-368 Beneficiary Addendum Monitoring Worksheet (WaCares Fund)
16-369 Staff Addendum Monitoring Worksheet (WaCares Fund)
17-011 Forms and Publications Request
17-041 Request for Records
17-063 Authorization
17-116 AIS TRACKS Fixed Asset Inventory Local Office Certificate of Completion
17-123 Spoken Language Interpreter Service Appointment Record