ICPCSupervisionReport.doc

ICPC Supervision Report Date of Report: / / Name of Child ren : Name of Caretaker s : Address of Placement: Caseworker: Phone Number: Reporting Period: Dates and locations of Face to Face Contact: Discuss child ren ’s current circumstances, addressing child ren ’s safety in current placement and child ren ’s well-being: Child ren ’s school performance, if applicable: Attach copies of report card, IEP, evaluations, if applicable Child ren ’s health medical status, including dates of medical and dental appointments and names of service providers, if applicable: Attach records, evaluations, therapy reports if applicable List any unmet needs, and recommendations to meet those needs: Sending state is responsible for case planning and for funding Supervising Worker’s Recommendation: Continue placement. Finalize adoption. Establish Guardianship. Return custody to parent, terminate jurisdiction. Other specify : Page 1 of 1