Front page | Washington State Department of Children ...
Please complete the following information for a change in provider site. For children attending a provider outside of your Corporation, please have the parent/guardian contact our office at 844-626-8687 to report. Please submit forms to ProviderHelp@dcyf. FORMCHECKBOX Temporary FORMCHECKBOX PermanentPrevious SSPS Provider Number: FORMTEXT ?????Client Identification Number: FORMTEXT ?????Child(ren) Name(s): FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????New SSPS Number: FORMTEXT ?????Start Date: FORMTEXT ?????Date of Return to Previous Site (if applicable): FORMTEXT ?????By signing this form, you are reporting a change in your provider site.Parent Name (printed) FORMTEXT ?????Parent Signature _______________________________ Date FORMTEXT ?????Notice: Change in providers must be reported within 5 days of the change occurring. WAC 110-15-0031 Please submit copy of form to ProviderHelp@dcyf. ................
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