Application Packet Forms
Fact Sheet
Disqualifying Criminal Offenses
Application for Child Placement
Request for Home Study
Service Agreement
Ohio State Child Abuse Request Form
Agency Policies Acknowledgement Form

Original or Update Home Study Forms

Home Study Checklist

Instructions for Criminal Clearings
Training Verification Form
Medical Statement ODJFS Form 01653
Release of Information Mental Health History
Reference Letter
Adult Child Reference Letter
Guardianship Form
Financial Statement ODJFS Form 01681
Financial Requirements Form
Child Characteristics Checklist ODJFS Form 01673A
Release of Information
Large Family Assessment Questionnaire
Safety Audit ODJFS Form 01348
Fire Inspection ODJFS Form 1200
Evacuation Plan
Post Placement Verification Form
Fee Schedule Form
Paperwork Completion Form
Release of Information Previous Home Study

Post Placement Request Form
Request for Post Placement Visit

Agency Policies
AHSS Agency Policies revised 3-03-2018

Agency License

Office phone: 330-829-9400
Brenda's Cell Phone: 330-206-2218
Fax: 330-823-1755
Mail: 358 Edna St. Alliance, Ohio 44601