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 | |
|---|---|---|---|
| 02-743 | Community Instructor Training Report (Home and Community Services) | ||
| 02-714 | Community Instructors Virtual Classroom Training Application (Home and Community Services) | ||
| 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 | ||
| 05-277 | Companion Home DCYF Weekly Schedule (Developmental Disability Administration) | ||
| 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) | ||
| 10-685 | Companion Home Provider Supplemental Information (Developmental Disabilities Administration) | ||
| 15-516 | Companion Home Quarterly Report (Developmental Disabilities Administration) | ||
| 10-642 | Components of Your 75 Hour Home Care Aide Training Program (Home and Community Services) | ||
| 10-596 | Comprehensive Functional Assessment of Adult Training Programs | ||
| 10-349 | Comprehensive Regional Review Tool | ||
| 10-558 | Comprehensive Resident / Representative Interview (Residential Care Services) |
