Fillable EXTENDED FAMILY AND FAMILY FRIEND INFORMATION FORM Inst (State of Alaska)

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EXTENDED FAMILY AND FAMILY FRIEND INFORMATION FORM Inst (State of Alaska)

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The EXTENDED FAMILY AND FAMILY FRIEND INFORMATION FORM Inst (State of Alaska) form is 2 pages long and contains:

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Country of origin: US
File type: PDF

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1
EXTENDED FAMILY AND FAMILY FRIEND INFORMATION FORM
Inst
ructions: This form may be completed immediately after a child has been removed from their
home, or anytime an extended family member or family friend tells a Tribal worker they want
placement of a child in State custody.
• Give one copy to the primary OCS worker (email, fax, or delivered by hand)
• Give one copy to the OCS Regional ICWA Specialist (email, fax, or delivered by hand)
Tribe:
Address:
Phone:
Person submitting form:
Date submitted:
P
arent and Child Information
Mother:
Father:
Children:
Extended Family or Family Friends Requesting Placement
The extended family members and/or family friends below have been in contact with the Tribe and
are willing and able to take immediate placement of the above children.
Name
Birth Date
(if known)
Relationship to
Child (if not
related, enter
family friend)
Mailing Address and
E-Mail Address
Phone
If
needed, list additional names and contact information on another piece of paper and attach. Please
specify if the individual is requesting immediate and permanent placement so a proxy form can be
completed and filed.
2
Other Extended Family and Potential Placement Resources
These extended family members and/or family friends have either not been contacted by the Tribe or
are not willing and able to take placement of the above children at this time.
Name
Birth Date
(if known)
Relationship to
Child (if not
related, enter
family friend)
Mailing Address and
E-Mail Address
Phone
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EXTENDED FAMILY AND FAMILY FRIEND INFORMATION FORM Inst (State of Alaska)

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Completed 21 January 2021

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