Covenant Kids Kinship Home Assessment Documents
These forms are listed in the order of use and by the title of how they should be saved.
1-Initial Phone Contact Checklist
 This is the form that CK Staff will use to make your first phone contact with the applicant.
It is best to get as much information on references as possible during this phone
conversation to ensure that there is adequate time to make contact with the applicant’s
references. Contact the family and reply to CK Region Referral within 24 hours of receipt
of referral to accept or reject the referral. Accepting a referral indicates acceptance of the
Due Date, as well. You will also need to email the CK Supervisor to notify them of the
date on which the home visit has been scheduled.
2a-Reference Contact Information Form for Applicant
 Use this form to email to applicants if they do not have contact information for 5
references and their adult children available during your initial contact. Ensure that if this
form is emailed, that the applicant either email the form back completed, or that it is
picked up at the home visit. All references should be obtained by phone. References may
not be the cause for an assessment being late.
2b-Reference Questions
 This will be used to interview all references.
2c-Adult Child Reference Questions
 These are the questions to ask of any adult child that does not reside in the home. If you
are interviewing other children of the caregiver that reside with another parent and are
over the age of 12, use this form as well.
 In reference to applicant’s minor children not living in the home - It will be important to
speak with the child’s guardian to gain permission before speaking with the child.
3a-Kinship Manual - English
 This document is to be left with the applicant for Kinship Assessments. It may be
emailed to applicants that are comfortable receiving it this way, and who have the ability
to receive and review it on a computer.
3b-Kinship Manual - Spanish
 This document is to be left with the applicant for Kinship Assessments. It may be
emailed to applicants that are comfortable receiving it this way, and who have the ability
to receive and review it on a computer.
4a- Release of Information - English
 Staff should take two copies of this document depending on the applicant’s primary
language (English or Spanish). Make sure that the applicants sign each copy so that they
have one for themselves and one for the file. Submit this with the Kinship Assessment.
4b- Release of Information - Spanish
 Staff should take two copies of this document depending on the applicant’s primary
language (English or Spanish). Make sure that the applicants sign each copy so that they
have one for themselves and one for the file. Submit this with the Kinship Assessment.
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Kinship Home Assessment Documents
Revised 01.17.2012
5a- General Information Form
 This form is used to obtain general information on each household member. Staff can
complete the sections of the document that they already have information on (such as
name, date of birth and relationship to child), but a majority of the information will need to
be obtained at the home assessment including a physical description of the household
members. If 5c-CPS Kinship Profile Questionnaire has already been completed by the
family, review the answers so as not to duplicate the questioning except for clarification.
5b-Covenant Kids Kinship Home Assessment Questionnaire
 This is the form that will be utilized to complete a bulk of the home assessment. There
are prompts in the questionnaire to assist in obtaining information and what to look for in
the home. If 5c-CPS Kinship Profile Questionnaire has already been completed by the
family, review the answers so as not to duplicate the questioning except for clarification.
5c-CPS Kinship Profile Questionnaire
 In most cases, this document will be sent to families prior to referral. Encourage the
family to complete this document and have it ready for you at the time of your visit. If
they have not yet received it, and have access to e-mail, you may send this document to
them. Completion of this document is not required, but it will make your job much easier
if it is already completed, in which case you may review it with the family to confirm
details.
6a-Risk Assessment Form
 This form is an assessment to be made by the assessor. A copy of the form can be taken
to the home assessment to ensure that all areas are addressed, but the specific
questions should not be asked of the household members. Complete this as an
assessment of all current household members, as well as taking into account the addition
of the children being considered for placement. Submit this with the Kinship Assessment.
6b-Risk Assessment Definitions
 The Risk Assessment definition form is to be used to complete the Risk Assessment
form. This is an information/reference guide, only and is not to be turned in to CK or CPS.
7- Covenant Kids Kinship Home Assessment Instruction Guide
 This document is to be used to write your home assessment. Please ensure that you are
covering all of the required items as these were taken directly out of our contract.
8-Kinship Caregiver Home Assessment Template – Form 6588
 Write your home assessment in this form. This will be the Kinship Assessment that you
submit.
9a-Withdrawal Report
 This document is to be used when the assessment needs to be withdrawn.
9b-Family Withdrawal Form
 This document is to be used for face-to-face withdrawals.
10-Court Related Services Case Note – Form 2057
 This form will be required if you are requested by CPS Staff to appear in court.
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Kinship Home Assessment Documents
Revised 01.17.2012