CPS BIPP Referral Form

THIS FORM IS INTENDED FOR CHILD PROTECTIVE SERVICES USE ONLY. 

Although parents with open CPS cases may seek DCFOF BIPP classes on their own, this form must be received prior to an appointment for CPS referred parents to receive services.


Please fill the form out in its entirety. If there is a question that does not apply to this client, write N/A. 
Referral Information

















Client Case
Reason for Referral

If you are uncertain what services would benefit your client most, please consult David Almager at 940-387-5131 x238.







If you have NOT checked any of the above boxes this client is NOT appropriate for BIPP Services.
Immediate Safety Concerns for Victim(s)







Protective Order






Other Victimization History






Please not that Child Safety Plans, Domestic Violence Safety Plans, Parental Child Safety Placement tools, and/or Removal Affidavits ARE REQUIRED to be sent with this referral form. DCFOF Cannot accurately assess the client's current situation, active safety threats, and The Department's concerns, without having these documents and being as informed as possible of the totality of the client's circumstances.

BY SUBMITTING THIS FORM YOU ARE CERTIFYING THAT YOU HAVE ATTACHED ALL REQUESTED AND PERTINENT PAPERWORK PERTAINING TO THIS CLIENT AS REQUESTED BY DCFOF  IN ORDER FOR YOUR CLIENT TO RECEIVE SERVICES.
Thank you! If you have any questions about this referral, please email David Almager at 940-387-5131 x238.