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
10-665 Alternative Living Provider Application (Home and Community Living Administration)
10-679 Alternative Living Provider Application, Certification, and Contracting Checklist (Home and Community Living Administration)
10-269 Alternative Living Services Plan and Provider Progress Report (Developmental Disabilities Administration)
10-269A Alternative Living Services Plan and Provider Progress Report Supplement to DSHS form 10-269 (Developmental Disabilities Administration)
10-467 ALTSA Sentence / Copy Design Folstein MMSE (Home and Community Services)
27-110 Applicant Request for a Copy of Background Check Information
19-237 Application Budget Summary (Residential Care Services)
02-592 Application for Approval of Interpreter and Translator Continuing Education Activity
14-001 Application for Cash or Food Assistance
10-413 Application For Contract For Currently Licensed Assisted Living Facility