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(desc) | File Format | |
|---|---|---|---|
| 14-431A | Community Crisis Stabilization Services (CCSS) Medical / Dental Services Authorization (Developmental Disabilities Administration) | ||
| 10-660 | Community Engagement Quarterly Progress Report (Developmental Disabilities Administration) |
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| 15-550 | Community Instructor Application (Home and Community Services) | ||
| 15-549 | Community Instructor Application: DSHS Adult Education (Home and Community Services) | ||
| 02-692 | Community Instructor Class List Tracking Log | ||
| 10-641 | Community Instructor Qualification Tool (Home and Community Services) | ||
| 15-551 | Community Instructor Training Program Application and Updates (Home and Community Services) | ||
| 02-743 | Community Instructor Training Report (Home and Community Services) | ||
| 10-348 | Community Protection Program Information Checklist and Risk Assessment Consent (Developmental Disabilities Administration) | ||
| 15-365 | Community Protection Treatment Worksheet Quarterly Review | ||
| 11-164 | Community Rehabilitation Program (CRP) Services and Qualifications (Division of Vocational Rehabilitation) | ||
| 10-613 | Community Residential Services and Supports (CCRSS) Certification Evaluation Client Supports Observation (Residential Care Services) | ||
| 14-501 | Community Resource Declaration | ||
| 23-045 | Community Services Division (CSD) Financial Confidence Wheel (Economic Services Division) | ||
| 16-243 | Community Services Office (CSO) Compliments and Concerns (Economic Services Administration) | ||
| 15-514 | Companion Home (CH) Client Individual Financial Plan (IFP) (Developmental Disabilities Administration) | ||
| 15-512 | Companion Home and Alternative Living Services Incident Report (Developmental Disabilities Administration) | ||
| 09-995 | Companion Home Certification Evaluation (Developmental Disabilities Administration) | ||
| 17-257 | Companion Home Client Budget Worksheet (Developmental Disabilities Administration) | ||
| 17-258 | Companion Home Client Cash Ledger (Developmental Disabilities Administration) | ||
| 17-259 | Companion Home Client Inventory Record | ||
| 17-260 | Companion Home Gift Card or Pre-paid Credit Card Ledger (Developmental Disabilities Administration) | ||
| 21-061 | Companion Home Monthly Emergency Evacuation Practice and Water Temperature Record (Developmental Disabilities Administration) | ||
| 02-589 | Companion Home Outside Employment Notification and Review (Developmental Disabilities Administration) | ||
| 17-262 | Companion Home Physical and Safety Requirements Review (Developmental Disabilities Administration) |
