CPS FOCUS Father's Referral - NewDay Services for Children & Families

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CPS FOCUS- Father's Referral

PRIVACY & SECURITY STATEMENT

Note: If father has been convicted of child sexual abuse or it has been determined that he is RTB of child sexual abuse, he CANNOT attend FOCUS classes. Effective 8/31/2019, NO PAYMENT AUTHORIZATION (2054) IS REQUIRED. THANK YOU!

CPS FOCUS for Fathers Referral Form

* Indicates required field

Check One *

CPS-CVS CPS-FBSS CPS-Inv

Referring County-Choose One *

Caseworker Name *

Caseworker's Phone Number *

Caseworker Email *

Case # *

Case Name *

Father's Name *

Father's Cell *

Father's Email *

Alternative # *

Father's Date of Birth *

Is this a SAFE BABIES Tarrant County Case? *

Yes No

Is this case related to a Domestic Violence charge? *

Yes No

Is Father considered the RTB for DV? *

Yes No Undetermined

NOTE: (In Tarrant County Only): In addition to the FOCUS Class for Fathers, we MAY be able to connect your client to other services which may or not be on their service plan. Please check all that apply. *

Anger Management Domestic Violence Parenting Skills Financial Literacy Healthy Relationships Job Skill Development

Make any additional comments here: *

Submit

NewDay Services for Children and Families - MAIN OFFICE:

6816 Camp Bowie Blvd W., Ste 112, Fort Worth, Tx 76116

Hours

M-F: 9am - 5pm

Telephone

817-926-9499

Email

newday@newdayservices.org

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