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Families / All Categories

Process with Neeginan Institute of Applied technology - Training Request Form
This document is a training request form made by an EIA recipient to study at the Neeginan Institute of Applied Technology (NIAT), including specific details about funding. 
Department/Crown:Families
Categories:Education and Training, Families, Financial Assistance
Promissory Note
Department/Crown:Families
Proposal Development Funding Application and Program Guidelines
Application and Guidelines on how to apply for Proposal Development Funding.
Department/Crown:Families
Protocol for Early Childhood Transition to School for Children with Additional Support Needs
Protocol to ensure the smooth and positive transition of children with additional support needs into the school system.
Department/Crown:Families
Provincial Investigations (PI)Unit - Referral Form
This form must be completed in full in order to meet the requirement of notifying the Director of Child and Family Services of abuse allegations, per The Child and Family Services Act, Section 18(6) " Where an agency receives information that a child was or might have been abused by a person who provides work for or services to the agency or to a child care facility or other place where a child has been placed by the agency, the agency shall, in addition to carrying out its duties under subsection 18.4(1) and section 18.5, immediately report the matter to the director and the director shall investigate the matter and take such further steps as are required by this Act, prescribed by regulation, or as the director considers necessary.  This is an internal form that is filled out by agencies when reported abuse allegations.
Department/Crown:Families
Categories:Families, Youth
Provincial Psychology Services Referral Form
This internal referral form for behaviour psychology services is completed by Community Service Workers at Children's disABILITY Services and Community Living disABILITY Services.
Department/Crown:Families
Categories:Application, Families
Record of Child Care Employee
This form is used by child care centres to add, modify or remove employee information from facility employee records.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Licence
Record of Child Care Residents/Staff Licensed for Family/Group Child Care Homes
This record must be updated when there are any new residents, licensees, overnight or support staff in the home. 
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Application
Referral to Independent Living Program
When a youth is leaving the Child and Family Services System because they are approaching their 18th birthday, their caseworker must (if applicable) make a referral to independent living programs. The caseworker uses their agency form to make that referral. 
Department/Crown:Families
Categories:Application, Families
Registered Pension Plans and Retirement Supports
This document outlines types of funding support available to child care workers to help them plan for their retirement. Information is provided about eligibility and options for registered pension plans for full-and part-time child care workers, the matched registered retirement savings plan contributions and the long-term service recognition retirement benefit.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Employment, Families
Registration by Adopted Adult
Registration by Adopted Adult for Adoptions Finalized in Manitoba form: An adoptee can fill out this form to request a search for information on their birth family. If a disclosure veto has not been received, the Manitoba Post-Adoption unit will provide information to the adoptee.
Department/Crown:Families
Categories:Application, Families
Registration by Adoptive Parent for Adoptions Finalized in Manitoba
 This form allows an adoptive parent to share information on their adoptive child with their birth parents.
Department/Crown:Families
Categories:Application, Families
Registration Process for Online ID and Password
Form required by licensed child care facilities to register for access to the Child Care Online system.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Application, Families
Registration When Adoptee is Deceased for Adoptions Finalized in Manitoba
This form is used by the Adoption/Post Adoption unit to allow for an adoptive parent to notify the birth family of the death of the adoptee
Department/Crown:Families
Rehabilitation and Recovery Service Parent Wellness Initiative Referral Form
Refer to CMHA for the now defunct Parent Wellness Initiative (PWI)
Department/Crown:Families
Categories:Families, Financial Assistance
Rekey Authorization Form
New Key, Replacement, when lost, change of tenant or for contractors
Department/Crown:Families
Category:Families
Relationship Assessment Form
The information on this form is required to determine the nature of your relationship with the adult you live with for the purpose of assessing eligibility for Employment and Income Assistance (EIA).
Department/Crown:Families
Categories:Families, Financial Assistance
Renewal of Family Support Agreement (CFS-6)
Under the Child and Family Services Act, Subsection 15(2) Financial information and maintenance agreement the agency shall request the parent or guardian to agrees to pay to the agency maintenance for the child in accordance with the regulations . This is the renewal form and must not  be changed other than by an amendment to the regulation. This is an agency form and is filled out by a case worker.
Department/Crown:Families
Category:Families
Renewal Of License Application - Child Care Centre or Nursery School
Form required by child care centres and nursery schools to apply to renew a licence.
Department/Crown:Families
Categories:Families, Licence
Renewal of License Application - Family Child Care
Form required by family and group child care homes to apply to renew a licence.
Department/Crown:Families
Categories:Families, Licence
Renewal of License Application - Occasional Child Care Centre
Form required by an occasional child care centre to apply to renew a licence.
Department/Crown:Families
Categories:Families, Licence
Renewal of Voluntary Placement Agreement
A voluntary placement agreement may not last more than 12 months and may be renewed to a maximum of 24 months. This is a statutory regulated form embedded in The Child and Family Services Regulation
Department/Crown:Families
Category:Families
Rent Assist Application Form - Non EIA
Form required to apply for the Rent Assist benefit for people who are not receiving EIA benefits. To be completed by the applicant. 
Department/Crown:Families
Categories:Application, Families, Financial Assistance
Rent Assist Policy Manual for Households not enrolled on EIA
Non-EIA Rent Assist Policy Manual
Department/Crown:Families
Categories:Families, Financial Assistance
Rental Information Form
This form gathers information about rental arrangements made between a tenant who is an EIA participant and the landlord. 
Department/Crown:Families
Categories:Families, Financial Assistance
Report to the Adult Abuse Registry - Peace Officer
Adult Abuse Registry form for completion by a peace officer to report the name of the accused and the details of the offence, in accordance with the regulations, to the registrar.
Department/Crown:Families
Category:Families
Report to the Adult Abuse Registry Committee - Designated Officer
Not for Public Use. Application pursuant to Subsection 41(2) of The Adult Abuse Registry Act for access to the Adult Abuse Registry by a designated officer. Designated officer means an executive director appointed under The Vulnerable Persons Living with a Mental Disability Act, or a person specified with respect to any other designated Act (as defined in The Adult Abuse Registry Act).  
Department/Crown:Families
Category:Families
Report to the Adult Abuse Registry Committee - Designated Officer
The Vulnerable Persons Living with a Mental Disability Act requires that if, after an investigation the executive director must provide a report about the matter to the adult abuse registry committee, in accordance with the regulations
Department/Crown:Families
Category:Families
Report to the Adult Abuse Registry Committee - Designated Officer Report Pursuant to Section 8.2(1) of the Protection for Persons in Care Act
The Vulnerable Persons Living with a Mental Disability Act requires that if, after an investigation the executive director must provide a report about the matter to the adult abuse registry committee, in accordance with the regulations
Department/Crown:Families
Category:Families
Report to the Child Abuse Registry - Peace Officer
Not for Public Use.  This form is for a Peace Officer to provide the name of the person and the details of the offence to the Provincial Child Abuse Registry.  Where a person was found guilty, pleaded guilty to an offence involving the abuse of a child in a court in, or outside of Manitoba, the name of that person, the circumstances of the abuse and any sentence imposed must be reported for entry on the Child Abuse Registry.
Department/Crown:Families
Category:Families
Reporting Requirements for Nursery Schools
This letter outlines the financial reporting requirements of licensed nursery schools.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance, Licence
Request for Exemption to Trained Staff Requirements
This document is an application form to request an initial/extension of an exemption(s) to trained staff requirements, completed by ELCC licensed child care facilities as part of their staffing plan and noted as a condition on their facility license.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Licence
Request for Information from MEP
Request for information from MEP
Department/Crown:Families
Categories:Families, Financial Assistance
Requirements and Responsibilities of Early Learning and Child Care Building Fund Grant Recipients
This document is a list of requirements and responsibilities that must be met by the non-profit child care organization for funding to be received by Early Learning and Child Care Building Fund grant recipients.
Department/Crown:Families
Categories:Families, Financial Assistance, Licence
Requirements for Licensed Child Care Centres
This document summarizes the areas of compliance to be met (health, fire, zoning and building regulations) as well as child care licensing requirements, when constructing and/or renovating a space for use as a child care centre in Manitoba.
Department/Crown:Families
Categories:Families, Licence
Residential Care Licensing
This optical record form is completed by residential care facility operators or staff employed by operators or agencies for facility residents in instances where a record is required with respect to a resident's goals and treatment plan.  The facility must keep the record(s) on the resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Authorization for Non-Prescription Drugs
This form, completed by a qualified physician, licensed prescriber, or dispensing pharmacist, authorizes residential care facility operators or staff employed by operators or agencies to administer non-prescription drugs to facility residents.
Department/Crown:Families
Category:Families
Residential Care Licensing - Authorization for Self-Administration of Medication
This form, completed by a residential care facility resident's attending physician and supervising agency, authorizes residential care facility operators or staff employed by operators or agencies to allow the resident to self-administer medications as directed by the physician, provided that the facility maintains an appropriate level of drug security to prevent unauthorized access and risks to others.
Department/Crown:Families
Category:Families
Residential Care Licensing - Careprovider Homestudy
This form is completed by Residential Care Licensing staff as part of the application process for individuals who are interested in becoming a licensed care provider for the Community Living disABILITY Services program.  It provides information about the prospective care provider, such as their motivation to provide care, their personality, interests, and health, as well as information about their home, including its physical structure, other residents (if applicable), and sleeping accommodations.
Department/Crown:Families
Category:Families
Residential Care Licensing - Communication Skills Policy
This document outlines the standard communication skills and competencies required of service providers and staff responsible for providing care and supervision in residential care facilities.
Department/Crown:Families
Category:Families
Residential Care Licensing - Declaration of Criminal Record and Adult Abuse Registry Record (Host Family Homes)
This form is to be completed by respite providers and adult household members in a host family home encounter a significant delay in obtaining either a Criminal Record Check or an Adult Abuse Registry Check. This form is also to be completed by visitors who will be staying temporarily in a host family home for one to six months or 31 to 180 days in a one-year period.
Department/Crown:Families
Category:Families
Residential Care Licensing - Declaration of Criminal Record or Adult Abuse Registry Record (Shift-Staffed Homes)
This form is to be completed by applicants seeking to provide residential care in shift-staffed homes when there is a delay in obtaining a Criminal Record Check or an Adult Abuse Registry Check
Department/Crown:Families
Category:Families
Residential Care Licensing - Dental Record
This dental record form is completed by residential care facility operators or staff employed by operators or agencies for facility residents in instances where a record is required with respect to a resident's goals and treatment plan.  The facility must keep the record(s) on the resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Fire Drill Log Form
This form is completed by residential care facility operators or staff employed by operators or agencies on a monthly basis to record fire drills conducted at residential care facilities, including the date and time of drills, evacuation times, exits used, participant information, problems encountered, and actions taken.
Department/Crown:Families
Category:Families
Residential Care Licensing - Fire Safety Inspection Form
This checklist is completed by residential care facility operators or staff employed by operators or agencies on a monthly basis to record details of compliance or non-compliance with Residential Care Licensing fire safety requirements.
Department/Crown:Families
Category:Families
Residential Care Licensing - Incident Report Form
This form is completed by residential care facility operators or staff employed by operators or agencies to record details of accidents and incidents that involve residents of a residential care facility for reporting purposes.
Department/Crown:Families
Category:Families
Residential Care Licensing - Inspection Checklist
This form is completed by Residential Care Licensing staff at the time of on-site inspections of facilities to record the results of a facility's compliance or non-compliance with licensing requirements.
Department/Crown:Families
Category:Families
Residential Care Licensing - Inventory of Drugs for Disposal
This form is completed by residential care facilities or staff employed by operators or agencies and the receiving pharmacist when disposing unused, discontinued, or out-of-date narcotic or controlled drugs.  The facility must keep the form on file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Medical Record
This medical record form is completed by residential care facility operators or staff employed by operators or agencies for facility residents in instances where a record is required with respect to a resident's goals and treatment plan.  The facility must keep the record(s) on the resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Medication Administration Record
This form is completed by residential care facility operators or staff employed by operators or agencies on a monthly basis for each resident who received medication administration services.  The facility must maintain the form on each resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Narcotic/Controlled Drug Medication Inventory Record
This form must be completed by residential care facility operators or staff employed by operators or agencies for each narcotic/controlled drug order for each resident, as applicable.  The facility must maintain a separate form each narcotic or controlled drug order on the resident's file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Operator Declaration of Criminal Record and Adult Abuse Registry Record (Host Family Homes)
This form is to be completed by operators when requested by Residential Care Licensing (RCL).
Department/Crown:Families
Category:Families
Residential Care Licensing - Physical Structure Report Form
This form, completed by individuals who are interested in becoming a licensed or approved residential care facility operator as part of the application process, verifies the physical structure of the facility, including the number of rooms, number of storeys, heating, water and sewage, and bedroom dimensions. 
Department/Crown:Families
Category:Families
Residential Care Licensing - PRN Medication
This form is completed by residential care facility operators or staff employed by operators or agencies for each resident who takes PRN (i.e., as required) medications ordered by a physician.   The facility must maintain the form on each resident's personal file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Record Check and First Aid Requirements for Shift-Staffed Homes

This policy provides direction on Criminal Record Checks, Adult Abuse Registry checks, and First Aid requirements for staff providing residential care in shift-staffed homes.

Department/Crown:Families
Residential Care Licensing - Resident's Personal File Face Sheet
This form, completed and maintained by residential care facility operators or staff employed by operators or agencies, is kept on each residential care facility resident's personal file.  The form records information about the resident such as identifying information, medical contacts, financial information, and critical information.
Department/Crown:Families
Category:Families
Residential Care Licensing - Revisions to Menu
This form, completed by residential care facility operators or staff employed by operators or agencies in facilities with more than eight residents and kept on file for a period of at least three months, records necessary variations to the facility's weekly menu.
Department/Crown:Families
Category:Families
Residential Care Licensing - Risk Assessment Policy
This policy outlines the process for conducting Residential Care Occupancy Risk Assessments in shift-staffed residential care facilities operating under a letter of approval.  The policy also applies to host family homes (i.e., home shares) as best practice.
Department/Crown:Families
Category:Families
Residential Care Licensing - Staff Orientation Format
This orientation checklist is completed by residential care facility operators or staff employed by operators or agencies.  Residential Care Licensing requires operators to provide each employee with an orientation to residential care standards, policies, procedures, and routines using this form (or form in a similar format).  The operator must retain the form on each individual's personnel file.
Department/Crown:Families
Category:Families
Residential Care Licensing - Weekly Menu
This form, completed by residential care facility operators or staff employed by operators or agencies in facilities with more than eight residents and kept on file for a period of at least three months, is the weekly menu plan for the facility.
Department/Crown:Families
Category:Families
Residential Care Licensing - Where to Request Record Checks
This document provides information to service providers and staff working in residential care facilities about where to request Criminal Record Checks and Adult Abuse Registry checks.
Department/Crown:Families
Category:Families
Residential Care Rate Authorization
Authorization form for residential care rate.
Department/Crown:Families
Categories:Families, Financial Assistance
Respite in the Community - Guide for Parents
This document provides information to parents and guardians of children open to Children's disABILITY Services about when their child goes on an outing with a department-managed respite provider. This guide includes an activity plan that requests input from families to help plan outings.
Department/Crown:Families
Categories:Application, Families
Retirement Benefit for Manitoba Child Care Workers and Home Based Providers - Application Form
Form used to apply for a one-time payment of a retirement benefit to people who work in a Manitoba based non profit centre, Nursery School or licensed family or group child care home. Must meet eligibility requirements. 
Department/Crown:Families
Category:Application
Rewarding Volunteer's Benefit (RVB) Agency Letter
This is a template letter to an agency or placement site, providing contact information for an EIA participant with a disability seeking a volunteer opportunity to receive the Rewarding Volunteer's Benefit. 
Department/Crown:Families
Categories:Families, Financial Assistance
Rewarding Volunteer's Benefit (RVB) Interest/Skills Inventory Tool
This document supports the administration of the Rewarding Volunteer's Benefit for EIA participants with a disability. The form requests details about an EIA participant's education/training, employment history and interest/skills inventory as a tool to support participation in a Volunteer Plan.  
Department/Crown:Families
Categories:Families, Financial Assistance
Rewarding Volunteer's Benefit (RVB) Volunteer Log Sheet
This document is a Volunteer Log Sheet recording activities, time spent volunteering, and confirming volunteer participation of an EIA participant with a disability.  This form must be completed by the volunteer agency/placement site and sent to EIA staff to ensure proper administration of the Rewarding Volunteer Benefit.
Department/Crown:Families
Categories:Families, Financial Assistance
Rewarding Volunteer's Benefit (RVB) Volunteer Plan
This document provides details of the Volunteer Plan for an EIA participant with a disability, including volunteer agency/placement site information, volunteer availability, and acceptance of the plan as part of Rewarding Volunteer's Benefit. 
Department/Crown:Families
Categories:Families, Financial Assistance
Royal Bank Letter
This updated letter verifies information about the participant so that RBC may cash the cheque.  
Department/Crown:Families
Categories:Families, Financial Assistance
RRSP Contribution Reimbursement Application Form for family and group child care home providers and inclusion support workers in a child care home
The program reimburses up to 4% of employer pension contributions.  All employees are eligible to join the pension plan as soon as it is set up. For-profit child care centres are not eligible for funding. 
Department/Crown:Families
Categories:Application, Employment, Families
Rural Homeownership
It is the policy and program manual for The Rural Home Ownership Program
Department/Crown:Families
Category:Housing and Property
SCH1 Letter - School Supply Notification
Letter to advise on funds for school supplies.
Department/Crown:Families
Categories:Education and Training, Families, Financial Assistance
Schedule A (form attached to Service Purchase Agreement) Generic
Schedule "A" template to complete and attach to Service Purchase Agreements between Manitoba and a Service Provider summarizing essential terms and expectations.
Department/Crown:Families
schedule A - Assignment of Province of Manitoba Victims of Crime Benefits
Schedule "A" to be attached to the memorandum of understanding between Employment and Income Assistance (EIA) and Compensation for Victims of Crime (CVC) regarding those applying for or in receipt of EIA who have also applied to CVC.
Department/Crown:Families
Categories:Families, Financial Assistance
School Registration Form: Children in Care
This form is  used to register children in care into the school system. It is filled out  by the caseworker and a copy is kept in the child file.
Department/Crown:Families
Category:Families
Science of Early Childhood Development
Web page providing access to the Science of Early Childhood Development resources.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Education and Training, Families
SDAP Letter - Security Deposit Advance
Employment and Income Assistance form letter advising client of an approved security deposit advance.
Department/Crown:Families
Categories:Families, Financial Assistance
Section 31- Exemption for child more than 12 years old

This document outlines the steps when a licensed child care facility requests continued enrolment of a child with additional support needs over the age of 12 years at a Manitoba child care facility.  

Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Licence
Self Employment Agreement and Reporting (monthly)
This tool will assist you in determining if a worker is an employee or a self employed individual.  
Department/Crown:Families
Self Report (Disability category)
Self-report form to be completed voluntarily for to apply for benefits under the EIA persons with disabilities category.
Department/Crown:Families
Categories:Families, Financial Assistance, Health
Self-Managed Respite Service Audit/Review
This form is used by Children's disABILITY Services for reporting and accountability purposes to audit families with self-managed respite service agreements with the Department of Families.
Department/Crown:Families
Categories:Application, Families
Service Provider Check-In
This form is to be used by service providers to give feedback on how their programming is working for the FASD population they serve.
Department/Crown:Families
Site Assessments for Child Care Facilities
This document outlines the different areas that need to be assessed when looking at a space for viability as a child care facility in Manitoba, including its potential to meet Child Care Regulations.
Department/Crown:Families
Categories:Families, Licence
Special Needs Request Form
Form to be completed to request Special Needs.
Department/Crown:Families
Categories:Families, Financial Assistance
Sponsorship Consent and Acknowledgement
This form must be completed if you have been living in Canada for less than 10 years, received sponsorship and would like to apply for benefits under Employment and Assistance Programs. The form helps EIA staff to determine eligibility for enrolment. 
Department/Crown:Families
Categories:Families, Financial Assistance
Staff Replacement Grant Application and Payment

This policy outlines the procedures to apply for a Staff Replacement Grant and to receive payment for the actual cost of a replacement staff (substitute) while a child care assistant (CCA) in a centre or the licensee in a home-based facility participates in an approved early childhood education (ECE) workplace training program. 

Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Employment, Families, Financial Assistance
Statement of Account (re medical services)
This document is a Statement of Account form for services rendered by a health professional providing medical evidence for an EIA applicant with a disability.
Department/Crown:Families
Categories:Families, Financial Assistance, Health
Statutory declaration Form
This document is a legal Statutory Declaration form, to be completed when there has been a loss or theft of an EIA income assistance cheque or voucher.   
Department/Crown:Families
Categories:Families, Financial Assistance
Substitute Decision Maker Application for an Adult Abuse Registry Self-Check (Mail)

Under The Vulnerable Persons Living with a Mental Disability Act, certain requirements must be met in order for a substitute decision maker to be appointed for an individual. These requirements are addressed by the questions asked in this application form.

Department/Crown:Families
Category:Application
Summer Skills Maintenance Screening Information
This internal use assessment tool is completed by Children's disABILITY Services staff with input from families to assess need and to plan for Summer Skills Maintenance programming.
Department/Crown:Families
Category:Families
Supervising Naps
This document decribes the requirements for supervision of napping infants in Manitoba's licensed early learning and child care facilities.
Department/Crown:Families
Categories:Families, Licence
Supports Intensity Scale
The Supports Intensity Scale (SIS) is an assessment tool, completed in the form of an interview with the individual and members of their support network, that the Community Living disABILITY Services (CLDS) program uses to determine how often eligible participants need support, what type of supports they need, and how much support they need in areas of daily life.
Department/Crown:Families
Tax Release Form
The tax release form grants permission from an EIA applicant/participant for Revenue Canada to release Income Tax information to the Department of Families for the purpose of information verification.  
Department/Crown:Families
Categories:Families, Financial Assistance
Taxi Invoice
Taxi invoice
Department/Crown:Families
Categories:Families, Financial Assistance, Transportation
Teen Services Network Registration
The Teen Services Network hosts an annual professional development day. This form allows participants to register for the event. It is updated annually to reflect the date and location and is sent around to potential registrants via email approximately 3 months prior to the event. 
Department/Crown:Families
Category:Education and Training
Termination of Maintenance Enforcement Assignment of Benefits Calculation Sheet
This tracking sheet must be completed when the SAMIN maintenance warning "Maintenance Exceeds Net SA Payable" is received due to earnings/income but the participant has not yet reached "exit point".
Department/Crown:Families
Termination of Voluntary Placement Agreement
https://web2.gov.mb.ca/laws/regs/current/_pdf-regs.php?reg=16/99  To terminate a voluntary placement agreement, this form must be completed. 
Department/Crown:Families
Category:Families
The Job Centre - Distribution Log for Weekly Bus Passes, Vouchers and Bus Tickets
This document is a tracking sheet to record information about distribution of weekly bus passes, vouchers and bus tickets for EIA participants accessing services and supports from The Job Centre. 
Department/Crown:Families
Categories:Families, Financial Assistance
The Teacher's Manual to Completing the EDI
An instructional manual for teachers on how to navigate the online survey system.
Department/Crown:Families
Therapeutic Diet and Nutritional Supplement Request and Justification
The DHSU follows current partner program policies and legislation to determine eligibility for medical supply/equipment and diet requests. All requests must be completed by a health professional. 
Department/Crown:Families
Category:Application
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