Child Protective Services Case Transfer Request
Complete this form to request the transfer of a Child Protective Services case to another caseworker or department.
Case Number
*
Child's Full Name
*
First Name
Last Name
Child's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Caseworker Name
*
First Name
Last Name
Current Caseworker Email
*
example@example.com
New Caseworker Name
*
First Name
Last Name
New Caseworker Email
*
example@example.com
Agency/Department for Transfer
*
Reason for Transfer
*
Supervisor Approval Name
*
First Name
Last Name
Supervisor Approval Email
*
example@example.com
Supporting Documents (if any)
Upload a File
Drag and drop files here
Choose a file
Cancel
of
Additional Comments
Signature of Requesting Caseworker
*
Submit Transfer Request
Submit Transfer Request
Should be Empty: