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.
| Number | Form Name(asc) | File Format | |
|---|---|---|---|
| 15-554 | Facility Instructor Application (Home and Community Services) | ||
| 10-640 | Emphasis on Hands-On Skills Practice: Planning Attestation (Home and Community Services) | ||
| 02-714A | DSHS Virtual Classroom Training Application: Addendum to DSHS 02-714 (Home and Community Services) | ||
| 02-714 | DSHS Virtual Classroom Training Application (Home and Community Services) | ||
| 02-744 | DSHS Remote Skills Training Application: Virtual Classroom (Home and Community Services) | ||
| 04-452 | DSHS Community Services Survey (Community Services Division, Economic Services Administration) | ||
| 04-452A | DSHS Community Services Customer Survey (Community Services Division) | ||
| 27-225 | DSHS Claim of Stolen EBT Benefits: Food (Community Services Division) |
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| 27-208 | Declaration to Adult Protective Services | ||
| 27-155 | Declaration on Commercial Purposes | ||
| 18-433 | Declaration of Support Payments (Division of Child Support) |
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| 09-693 | Declaration of Lawful Custody |
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| 11-134 | Deaf - Blind Referral Criteria Checklist for Level 4 Community Rehabilitation Program (CRP) Services (Division of Vocational Rehabilitation) | ||
| 15-356 | DDA Community Protection Program Chaperone Agreement | ||
| 15-552 | Curriculum Approval Application (Home and Community Services) | ||
| 15-556 | Continuing Care Retirement Community (CCRC) Registration Renewal Addendum (Aging and Long-Term Support Administration) | ||
| 14-547 | Continuing Care Retirement Community (CCRC) Registration Application | ||
| 10-642 | Components of Your 75 Hour Home Care Aide Training Program (Home and Community Services) | ||
| 16-243 | Community Services Office (CSO) Compliments and Concerns (Economic Services Administration) | ||
| 23-045 | Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division) | ||
| 14-501 | Community Resource Declaration | ||
| 10-613 | Community Residential Services and Supports (CCRSS) Certification Evaluation Client Supports Observation (Residential Care Services) | ||
| 11-164 | Community Rehabilitation Program (CRP) Services and Qualifications (Division of Vocational Rehabilitation) | ||
| 15-365 | Community Protection Treatment Worksheet Quarterly Review | ||
| 10-348 | Community Protection Program Information Checklist and Risk Assessment Consent (Developmental Disabilities Administration) |
