Electronic DSHS Forms

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.

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Number(asc) Form Name File Format
14-225 Acknowledgement of Services
14-224 Statement from Landlord/Manager
14-223 Statement from School
14-155 Senior Citizens Service Application
14-151 Request for DDA Eligibility Determination
14-144A Medical Disability Decision
14-113 Your Cash and Food Assistance Rights and Responsibilities
14-105 Interview Appointment for Applicant (Community Services Division)
14-084 Social Service Referral
14-078 Eligibility Review
14-076 Change of Circumstances
14-068 Financial Statement (Division of Vocational Rehabilitation)
14-057D Child Support Referral Continuation
14-057B Noncustodial Parent Child Support Enforcement Application
14-057 Child Support Referral
14-050 Statement of Health, Education, and Employment
14-012 Consent
14-001 Application for Cash or Food Assistance
13-956 Skin Observation (Developmental Disabilities Administration)
13-955 Vital Signs Tracking (Developmental Disabilities Administration)
13-954 Seizure Protocol (Developmental Disabilities Administration)
13-953 Medication Administration Record (MAR) (Developmental Disabilities Administration)
13-952 Bowel Protocol (Developmental Disabilities Administration)
13-951 Aspiration / Choking Plan (Developmental Disabilities Administration)
13-945 RCS Certified Community Residential Services and Supports (CCRSS) Infection Prevention and Control (IPC) Assessment Notes (Residential Care Services)