Form Dcyf 035A PDF Details

Ensuring the safety and well-being of children in Rhode Island, especially those involved with childcare facilities, foster care, or adoption processes, necessitates thorough screening and vetting of individuals and organizations. The State of Rhode Island Department of Children, Youth, and Families (DCYF) has instituted a rigorous process to facilitate this through the DCYF Clearance Request/Results (Facility) Form, otherwise known as DCYF 035A. This form is a critical tool in the effort to maintain a safe environment for children, requiring a $10.00 fee and stringent adherence to the payment method specified, underscoring the seriousness with which these checks are conducted. Addressed to specific facilities like The Groden Center, the form seeks to streamline communication and ensure precise delivery of results. It outlines various roles that require clearance, including prospective childcare operators or employees, foster care providers, non-DCYF adoption employment, volunteers in various capacities, and others in positions of authority over children. The included Information Release segment is a testament to the thoroughness of the screening process, necessitating authorization from the applicant allowing DCYF to conduct checks against indicated child abuse/neglect records as per R.I.G.L. 40-13.2-3.1, further emphasizing the rigidity and thoroughness of the process to protect children's welfare.

QuestionAnswer
Form NameForm Dcyf 035A
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesstate of rhode island dcyf clearance request, dcyf clearance request ri, dcyf ri, dcyf ri clearancerequest form

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STATE OF RHODE ISLAND

Department of Children, Youth and Families

101 Friendship Street

Providence, RI 02903

DCYF Clearance Request/Results (Facility)

$10.00 fee enclosed (agency check, cashier check or money order – no personal checks accepted. Requests submitted without payment will not be processed.)

**Please make checks payable to the General Treasurer State of Rhode Island**

Facility Name:

The Groden Center

Mail clearances to:

 

Mailing:

 

The Groden Center

Department of Children, Youth and Families

 

 

Attn: HR Dept.

Attn: Tamaneshia Toms

 

 

610 Manton Ave.

101 Friendship St.

 

 

 

Providence, RI 02909

Providence, RI 02903

E-mail address: kfalla@grodencenter.org / lmarshall@grodencenter.org

Phone:

 

401-274-6310 ext. 1233 or 1297

 

Please indicate:

Prospective Childcare operator or employee

Foster Care provider

Non-DCYF Adoption

Employment

Community Agency Volunteers who have

supervisory authority over children without the presence of others

Volunteer in a daycare

setting

Child Care and Community Agency Volunteers who do not have supervisory

authority over children without the presence of others

 

INFORMATION RELEASE

I hereby authorize the Department of Children, Youth and Families to release to THE GRODEN CENTER information obtained as a result of their check of the Department’s Indicated Child Abuse/Neglect records. I understand that this records check is required by R.I.G.L. 40-13.2-3.1 and that information obtained as a result of this check may be used by the Department or the facility in determining my suitability for employment in a Child Care facility. This authorization will expire upon receipt by the facility of the Clearance Check Results or thirty (30) days after the date of this authorization appearing below. Any information released and /or received as a result of this consent shall not be further relayed in any way to any person or organization outside of the Department without additional consent except as provided by statute.

Signature of Applicant

Date of Birth

Date of Authorization

 

 

 

 

Last Name

First Name

Middle

Maiden

Address

 

 

 

RICHIST:

# & Street

City/Town

State

Zip Code

BACKGROUND CHECK RESULTS

No Prior Contact

Case ID or Person ID:________________ Case Name:_____________ Status: Active

Closed

Investigation #

Level

Status

________________________

 

 

Name

___________________________________

MASTERFILE:(Prior to 1984)

Involvement

Allegations

No prior Involvement

 

 

DCYF#035A

 

Revised 4/26/12

(Use with Policy 700.0105)

 

 

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