Blue Earth County, MN · Blue Earth County
Child Foster Care Statement of Intended Use
Child foster care license holders complete this statement with the licensing agency to describe the intended placements and services their home will provide.
At a glance
- Issued by
- City of Blue Earth County · Blue Earth County, Blue Earth County, Minnesota
- Notarization
- Not required: file this form without a notary.
- Official source
- blueearthcountymn.gov
- Blank form
- Download the PDF
- Catalogued
- Machine-readable
- JSON record · about the forms index
What this form is
This statement records the intended use of a child foster care home and must be developed with the licensing agency and approved by that agency. License holders provide the home's licensed capacity, the age range of children served, placement limitations, and circumstances affecting the adult-to-child ratio. They also indicate the types of care offered and, when applicable, complete the respite services section before signing and dating the form.
Who needs it
Child foster care applicants or license holders work with their licensing agency to complete and obtain approval for this statement.
How to submit it
Submit it to the county department named on the form; check the county website for current contact details.
About notarization
This document is signed without a notary; the license holders and licensor sign and date it.
How to submit this form
- 1
Download the Statement
Download the Child Foster Care Statement of Intended Use.
- 2
Complete the Form
Enter the home's capacity, age range, placement limitations, ratio circumstances, and applicable care types.
- 3
Complete Applicable Sections
Family child foster care license holders complete the respite services section when it applies.
- 4
Sign and Submit
License holders and the licensor sign and date the statement. Submit it to the county department named on the form.
Frequently asked questions
- What does the Child Foster Care Statement of Intended Use record?
- It records the foster home's licensed capacity, the ages of children served, placement limitations, ratio exceptions, and the types of care offered. A section addresses respite services for applicable family child foster care homes.
- Who completes this statement?
- Child foster care applicants or license holders work with the licensing agency to develop the statement. The license holders sign and date it, and the licensor also signs and dates it to show approval.
- Do I need a notary for the Child Foster Care Statement of Intended Use?
- No. This document is signed without a notary; the license holders and licensor sign and date it.
- How do I submit the statement?
- The document does not give submission contact details. Submit it to the county department named on the form, and check the county website for current contact details.