Child Welfare Record Request:
Out of State Child Welfare Agencies

This request form is for use by employees, authorized agents, or contract providers of Departments, outside the State of Florida, responsible for carrying out: child protective investigations and/or ongoing child protective services as detailed in ยง 39.202(2)(l).

REQUESTING AGENCY INFORMATION
REQUESTOR INFORMATION
REQUEST

Specific Reason for the Request:

PLEASE PROVIDE THE FOLLOWING INFORMATION FOR THOSE PERSONS WHOM FLORIDA CHILD PROTECTIVE HISTORY IS REQUESTED.

Individual 1

Individual 2

Individual 3

Individual 4

Individual 5

Individual 6

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