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 Form Name(desc) File Format
20-334 Washington State Learning Center (LC) New Course Request (Division of Developmental Disabilities)
13-919 Weekly Status Update (Competency Restoration Program) (Behavioral Rehabilitation Administration)
13-928 Withdrawal of Petition for Conditional Release or Unconditional Release (Behavioral Health Administration)
03-389A Witness Report of Possible Client Assault (Per RCW 72.01.045, RCW 74.04.790)
14-381 WorkFirst Individual Responsibility Plan
14-113 Your Cash and Food Assistance Rights and Responsibilities
14-520 Your DSHS Cash or Food Assistance Benefits
16-279 Your Responsibility for Participation Towards Costs of Care at a Youth Transitional Care Facility (Developmental Disabilities Administration)
14-514 Your Responsibility to Pay Towards Costs of Care at the Residential Habilitation Center
14-521 Your Rights (Home and Community Services)
16-247 Your Rights and Responsibilities When You Receive MAC or TSOA Services Offered by ALTSA
16-172 Your Rights and Responsibilities When You Receive Services Offered by Aging and Disability Services Administration and Developmental Disabilities Administration
16-246 Your rights as a client of the Developmental Disabilities Administration