MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION REPORT FOR THE PROTECTIVE CUSTODY OR PRELIMINARY CHILD WELFARE HEARING
Date Submitted:
In the interest of:	Case Number:
Child Name	Date of Birth
Parent Name
Current or Last Known Address
Updated or corrected Information.

Reasonable efforts since removal:

Current placement of child or children:

Adjustment of the child or children since placement in protective custody:

Efforts by the Children’s Division to locate any absent parent:

Efforts by the Children’s Division to establish paternity:

Special needs of child or children:

School continuation plan for child or children:

Is the family an enrolled tribal member or eligible for enrollment in an American Indian/Alaskan Native tribe?:

Investigation into potential relative placements:

Bond conditions or orders precluding contact or visitation:

Visitation with siblings and other family members:

Recommendation:

Respectfully submitted,
Electronic Signature – CD Worker	Date
Electronic Signature - Supervisor	Date