PAPA Service Application

Information disclosed in this application form is used to establish the eligibility of the applicant(s) to receive services and the type of services appropriate in the circumstance. It will be kept confidential unless there is a court order requiring PAPA to disclose or there is reason to believe that the child(ren) need(s) protection and PAPA is obliged to report by law.

Applicant Information
surname		name		date of birth	(yyyymmdd)	sex	female male
employer		annual income		tel		e-mail
address		city		postal code
Spousal Information (Please leave this section blank if you do not have a spouse or if your spouse is not working with you in this child protection matter.)
surname		name		date of birth	(yyyymmdd)	spouse sex	femalemale
employer		annual income		tel		e-mail
child 1 surname		child 1 name		child 1 DOB		child 1 sex	femalemale
child 2 surname		child 2 name		child 2 DOB		child 2 sex	femalemale
Please enter more information of your children in the "Case Details" below if you have more than two.
social worker surname		social worker name		MCFD lawyer surname		MCFD lawyer name
court location		court date, if any		(yyyymmdd)	application date		(yyyymmdd)
Case Details (please tell us what has transpired that attracted the attention of MCFD) Suggested particulars you should include: Date of removal Reason for removal (eg. unexplainable physical injury, physical/sexual/mental abuse, neglect, drugs/alcohol) Placement and location (foster home, relatives, friends, community if known) Date of Hearing Was disclosure provided to you complete (all intake reports, few blacked-out sections, risk assessment, other)? Was a comprehensive risk assessment provided? Date of Case Conference, if any? Dates of intake reports and details? Any offer of mediation by MCFD? Medical and mental (psychological) conditions of yourself and children Source of complaint if known (anonymous, daycare, school, church, babysitter etc.) Location of removal (school, home, church, daycare, hospital) Is police involved or not (eg. any on-going criminal investigation, criminal charges laid)? What the Ministry is seeking (3/6-month extension, CCO, Supervision order)? Did Ministry offer any services before removal (parenting course, anger control management, etc.)? Has Ministry offered services since the removal? Has Ministry asked you to participate in a Parental Capacity Assessment? Has Ministry put your child through abuse examination (ie. HEAL Clinic in Surrey or other location)? Has Ministry indicated they wish to have a psychologist examine your child? Region and office location (ie. Vancouver Coastal, Fraser, Interior, North, Vancouver Island) having jurisdiction of your file Name of MCFD lawyer and primary social worker and their team leader, and community service manager Are you represented by a lawyer (legal aid or not)? Are you using an advocate to accompany you in court and in MCFD meetings? Communications with MCFD (cordial, non-existent, animosity, email, phone, in person, etc.) What does MCFD want from you in order to return your child(ren)? Visitation arrangements (supervised at home, at facility, number of hours, visits per week) Is MCFD requiring you to take time off work in order to make these visits? Are you receiving copies of the supervision reports (if not, ask for them)? Voice contact allowed (yes, no, constrained, webcam, monitored by foster parent) Is community support available (ie. church, ethnic association etc.)? Do you have relatives that can take child instead of foster care? Do Family Relations Act custody issues exist with another parent, or relative?
Help Sought: (may check more than one)  provide emotional and peer support   connection with other parents   direction to information   appear in court and meetings  (subject to availability of our volunteers)  referral to to other support groups   assistance to go public
Image Verification Please enter the text from the image.          Refresh Image               By pressing the "Submit" button above, you hereby certify that: you have not abused your children as defined by law; the information provided is true, accurate and complete; there is no reason in the information provided for its readers to believe that child protection is needed; intervention from the MCFD is unfair and unjustified. Furthermore, you save PAPA, its directors, officers, representatives and volunteers harmless from all legal actions against actions taken in good faith and any professional services, if applicable, referred to and subsidized. Applications for service are subject to approval and may be terminated by PAPA at any time at our sole discretion.