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Families / All Categories

Family Support Service Agreement (CFS-5)
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 form 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
Family Violence Prevention Program (FVPP) - Standards Manual for Shelters
The standards manual outlines minimum requirements for all women's shelters in receipt of public funds in the form of core grants provided by the Government of Manitoba.
Departments/Crowns:Environment and Climate, Families, Sport, Culture and Heritage
Family/Group Child Care Home Operating Grant Application
Form required for family or group child care providers to apply for operating grant funding.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance
FASD Evaluation Manual for Service Providers
This guide provides the programs involved in the evaluation of Manitoba's FASD Strategy with information on the purpose of the evaluation and how to fill out the required forms.
Department/Crown:Families
Fire Health Inspection Request Form
This document is the template for a Fire Inspection or Public Health Inspection Request Form that is required by all  ELCC licensed child care centres, family and group child care providers.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Licence
FNIN Letter - Mass Notification FNIHB
Mass notification letter regarding insured health benefits.
Department/Crown:Families
Categories:Families, Financial Assistance
Focus on Employment Referral Form
This document is a referral form for an EIA participant with a disability or disability related barriers to employment to apply for employment supports provided by Focus on Employment Inc. (Swan River, Manitoba).
Department/Crown:Families
Categories:Employment, Families, Financial Assistance
Form CA-1 Notice of Opportunity to Provide Information
Not for Public Use.  Form CA-1 Notice of Opportunity to Provide Information is a form in the Child Abuse Regulation Schedule, as provided in subsection 11(1), that the child abuse committee is to give a person who is suspected of having abused a child an opportunity to provide information to the committee by giving the person a copy of this form.
Department/Crown:Families
Category:Families
Form CA-2 Affidavit of Service of Notice of Opportunity to Provide Information
Not for Public Use.  Form CA-2 Affidavit of Service of Notice of Opportunity to Provide Information must be completed when a Notice is given in accordance with subsection 11(5) of the Child Abuse Regulation. 
Department/Crown:Families
Category:Families
Form CA-3 Notice of Intended Entry on Child Abuse Registry
Not for Public Use.  Form CA-3 provides the person to whom it is addressed of Notice of Intended Entry on the Child Abuse Registry in accordance with subsection 19(3) of The Child and Family Services Act.  CA-3 is a form (pages 19 to 20) in the Child Abuse Regulation Schedule. 
Department/Crown:Families
Category:Families
Form CFS-17
This form is to notify a parent or guardian of when their next court date is.This is a statutory regulated form embedded in The Child and Family Services Regulation, This is a form used by the agency.
Department/Crown:Families
Category:Families
Forty Hour Course Options for Child Care Assistants and Home-Based Child Care Providers
In Manitoba, all Child Care Assistants and licensed home-based child care providers are required to complete a 40 hour course related to early childhood education within the first year of employment. This web page describes options for completing the required 40 hour course.
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Education and Training
Foster Children Application Form
Application form to be completed by a Child and Family Services social worker to apply for child care subsidy for a foster child.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance, Youth
Foster Family Manual
The foster family manual contains information that you need to know in your role as a foster parent.
Department/Crown:Families
Category:Families
Foster Family Questionnaire
This is the second part of the foster family application that explores relationships with children, discipline, neighbour hood and requests additional information. This form is to be filled out with a casework on the agency letterhead.
Department/Crown:Families
Category:Families
Foster Family Release of Information Form
When a foster family changes agencies and/or Authorities, they fill out this form so that all the information in their foster family file can be forwarded to the new agency. This form is located on the CFSIS system and the caseworker will download on agency letterhead.
Department/Crown:Families
Category:Families
Foster Family Transfer Agreement Form
This form is an internal form used when a foster family moves from one agency to another. It gives permission to transfer the foster home license to another agency.
Department/Crown:Families
Category:Families
Foster Home Review/Relicensing Guidelines
Annually the foster home license must be renewed. Each agency has their own forms on their letterhead which the foster home worker will fill out with the foster parents.
Department/Crown:Families
Categories:Application, Families
Foster Parent Intentional Damage Compensation Plan and Form

The plan provides coverage for intentional damage occurring in foster homes. Coverage applies to the property of home operators or to the property of others in care, custody and control of the foster home.

Department/Crown:Families
Categories:Application, Families
Frequently Asked Questions (Accessibility Standard for Customer Service)
This document provides frequently asked questions and answers on the Accessibility Standard for Customer Service.
Department/Crown:Families
Category:Families
Funding Policies and Procedures :Family/Group Child Care
This document describes guidelines and the application form required for licensed family and group child centres to apply for an ELCC operating grant.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance
Funeral Invoice Schedule B
Invoice used by Funeral Directors for services covered by EIA.
Department/Crown:Families
Categories:Families, Financial Assistance
FVPP Statistical Report for the Couple's Counselling Project

This form is used by the Couples Counselling Project to report statistical data on a quarterly basis.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for Access Exchange Programs
The standards manual outlines minimum requirements for access exchange programs in receipt of public funds in the form of core grants provided by the Government of Manitoba.
Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for MaMaWi

The standards manual outlines minimum requirements for the Ma Mawi Wi Chi Itata Centre Spirit of Peace Program which receives public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for MAPS (Men Are Part of the Solution)

The standards manual outlines minimum requirements for the MAPS (Men Are Part of the Solution) organization, which receives public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for Nor'West Community Health Centre

The standards manual outlines minimum requirements for Nor'West Community Health Centre, which receives public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for Residential Second Stage Programs

The standards manual outlines minimum requirements for all second stage facilities in receipt of public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for TLC (The Laurel Centre)

The standards manual outlines minimum requirements for The Laurel Centre, which receives public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for Wahbung Abinoonjiiag

The standards manual outlines minimum requirements for Wahbung Abinoonjiiag which receives public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for Women's Resource Centres

The standards manual outlines minimum requirements for women's resource centres in receipt of public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Standards Manual for Women's Resource Centres with Residential Services

The standards manual outlines minimum requirements for women's resource centres with residential services in receipt of public funds in the form of core grants provided by the Government of Manitoba.

Departments/Crowns:Environment and Climate, Families
FVPP - Supervised Access/Exchange Service Statistical Report

This form is used by Access Exchange Programs to report statistical data on a quarterly basis.

Departments/Crowns:Environment and Climate, Families
FVPP - Urban Support Program Statistical Report

This form is used by Urban Support Programs to report statistical data on a quarterly basis.

Departments/Crowns:Environment and Climate, Families
FVPP A Woman's Place Statistical Report

This form is used by A Woman's Place to report statistical data on a quarterly basis.

Departments/Crowns:Environment and Climate, Families
FVPP Client Statistics for Residential Second Stage Housing Providers

This form is used by Second Stage Service Providers to report statistical data on a quarterly basis.

Departments/Crowns:Environment and Climate, Families
FVPP Couple's Counselling Program Statistical Report YWCA of Brandon

This form is used by the YWCA Brandon to report statistical data on a quarterly basis.

Departments/Crowns:Environment and Climate, Families
FVPP Shelter to Shelter Transfer

This form is used by women's shelters when arranging a transfer of a client to another women's shelter.

Departments/Crowns:Environment and Climate, Families
Grab Bar & Transfer Pole Installation Fax Form
Grab bar and transfer pole installation form.
Department/Crown:Families
Categories:Families, Financial Assistance, Health
Guide (public facing) Rental Housing Construction Tax Credit program Guide
A guide to the rental housing construction tax credit program
Department/Crown:Families
Category:Housing and Property
Guide for Public Sector Organizations
This guide was created by the Disabilities Issues Office to help Manitoba public sector agencies develop an accessibility plan, in compliance with The Accessibility for Manitobans Act.
Department/Crown:Families
Guide to the Inclusion Support Program
This is a detailed guide informing parents and staff at child care centres, nursery schools, and family and group child care homes about all aspects of the Inclusion Support Program (ISP). The ISP program, guided by an Individual Program Plan reduces or eliminates barriers so that children with additional support needs are able to meaningfully participate in licensed child care programming.
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Families
Guidelines for Completion of the Families First Home Visitor Log
An internal document for public health outlining the process to complete the Families First screen form.
Departments/Crowns:Families, Health
Guidelines for Completion of the Families First Screening Process
This is an internal document for public health that outlines the process to complete the Families First screen form.
Departments/Crowns:Families, Health
Guidelines for Extended Hour Child Care Services for Day Care Centres and Family Day Care Homes
This document informs licensed child care facilities how to request extended hour child care service for families, beyond the normal operating hours of a child care facility, including evening, overnight and weekend care.
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Families
HCMO Cash flow & Expenditure Report #1
Projection of cash flow for the fiscal year for community agencies/individuals who have a Service Purchase Agreement with Healthy Child Manitoba Office. This form is due at the beginning of each fiscal period. 
Department/Crown:Families
Category:Business
HCMO Cash flow & Expenditure Report #2
6 month reporting of actual expenditures with a projection to the year's end. This financial report is completed by community agencies/individuals who have a Service Purchase Agreement with Healthy Child Manitoba Office. 
Department/Crown:Families
Category:Business
HCMO Cash flow & Expenditure Report #3
Year end final report of actual expenditures. This form is completed by community agencies/individuals who have a Service Purchase Agreement with Healthy Child Manitoba Office. It reflects the projection and actual expenditures for the entire fiscal year and is due at the end of each year. 
Department/Crown:Families
Category:Business
HCMO Organizational Identifying Info
A form filled out by HCMO funded agencies to provide information on their organizational structure. 
Department/Crown:Families
Category:Business
HCMO Program Progress Report
A report completed by funded agencies detailing the progress/activities completed under the terms of their Service Purchase Agreement. 
Department/Crown:Families
Category:Business
HCMO Reporting Schedule - Healthy Baby/Funded Agencies
Form issued on a yearly basis to inform funded agencies of the timelines for completing Healthy Baby program and financial reporting (as outlined in the SPA). 
Department/Crown:Families
HCMO Staffing Report
A form filled out by HCMO funded agencies to report the number of staff employed in their funded programs and their respective classifications. 
Department/Crown:Families
Category:Business
Healthy Baby - Participant Contact Form
Form for Healthy Baby Community Support Program service providers to complete when contact has been made with Manitoba Prenatal Benefit applicants who've signed a consent to be contacted.
Department/Crown:Families
Healthy Baby Community Program Guide
Comprehensive document that directs and guides the administrative and service delivery priorities for funded agencies who provide HB programming in the province. Core program elements, standards and research/evidence based practice ensure consistent application meeting the needs of participants, service providers and government. 
Department/Crown:Families
Healthy Baby Letter - Application reassessment
Letter to applicant confirming request for re-assessment based on change in current year income. This letter requests statements of current year earnings and explanation as to why income has dropped.
Department/Crown:Families
Healthy Baby Letter - Approval
Letter to applicant confirming approval of Prenatal Benefits.
Department/Crown:Families
Healthy Baby Letter - CYA Approval
Letter to applicant to advise of benefit approval upon receipt of current year income information.
Department/Crown:Families
Healthy Baby Letter - Had Baby
Letter to applicant to advise of file closure due to early birth.
Department/Crown:Families
Healthy Baby Letter - Rejection Current Year Income
Rejection notification letter to applicant explaining that current year income totalled more than $32,000.
Department/Crown:Families
Healthy Baby Letter: Notice of Assessment
Letter to applicant requesting Notice of Assessment to meet eligibly requirement.
Department/Crown:Families
Healthy Baby Postnatal Attendance & Infant Feeding
Data collection form Healthy Baby participants complete related to infant feeding and tracking their attendance at a Healthy Baby program (as outlined in the SPA).
Department/Crown:Families
Healthy Baby Prenatal Attendance
Data collection form Healthy Baby prenatal program participants complete to track their attendance at a Healthy Baby program (as outlined in the SPA).
Department/Crown:Families
Healthy Baby Program Budget Notes
This is a form that funded agencies who provide Healthy Baby complete on a yearly basis to inform Healthy Child Manitoba Office of projected costs related to program operations. 
Department/Crown:Families
Category:Business
Healthy Baby Session Tracking Sheet
Data collection form Healthy Baby service providers complete after each Healthy Baby session to detail program participation and activities (topics, milk coupon program etc.).
Department/Crown:Families
Healthy Baby: Manitoba Prenatal Benefit Application
Application form for the Manitoba Prenatal Benefit
Department/Crown:Families
Healthy Baby: We're Glad You're Here Postnatal
Data collection form Healthy Baby postnatal program participants complete when they attend a Healthy Baby program (as outlined in the SPA)
Department/Crown:Families
Healthy Baby: We're Glad You're Here Prenatal
Data collection form Healthy Baby prenatal program participants complete when they attend a Healthy Baby program (as outlined in the SPA).
Department/Crown:Families
Hearing Aid Claim Form
Hearing aid pre-approval/claim form.
Department/Crown:Families
High Fidelity Wraparound Registration Letter
The letter gathers basic information from training registrants (name, address, dietary concerns, etc).
Department/Crown:Families
Housing Program Contribution Agreement with Appendices (Metis Housing)
An agreement between MHRC and the organization that stipulates the terms.
Department/Crown:Families
IDL1 Letter - Excess Income No Benefits Issued
Letter sent explaining no benefits will be issued as earnings exceed EIA budget.
Department/Crown:Families
Categories:Families, Financial Assistance
In-Home Respite - Guide for Parents
This document informs parents about in-home respite for a child receiving support through Children's disABILITY Services. The guide is accompanied by a form requesting descriptive information about a child's care, routines and activity interests, behavioural issues, to be completed by parents and the direct service provider.
Department/Crown:Families
Categories:Application, Families
Inclusion Support Program - Consent for Release of Personal Information and/or Personal Health Information
This document is a template of the Consent Form granted by a parent/guardian to release personal information and/or personal health information for a child participating in the ELCC Inclusion Support Program.
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Families
Inclusion Support Program - Individual Program Plan
This form is a detailed Individual Program Plan for a child participating in the Early Learning and Child Care Inclusion Support Program. The document includes information about the medical needs of the child and records details of actions for short and long term planning.
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Families
Inclusion Support Program - Staffing Grant Payment Form
The staffing Grant Payment Form reports the children's attendance and salary and benefits paid under the Inclusion Support Program. The child care facility completes this form every four week billing to claim approved grant funding under the program.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Application, Families
Inclusion Support Program Eligibility Application

This policy outlines the eligibility criteria for the Inclusion Support Program (ISP) as it applies to children, families and facilities, as well as the related procedures. 

Departments/Crowns:Education and Early Childhood Learning, Families
Category:Families
Inclusion Support Program Eligibility Application
This form is required by the ELCC Program to determine eligibility for supports under the Inclusion Support Program.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Application, Families
Inclusion Support Program Guaranteed Space Payment Application
This document is a template of a Guaranteed Space Payment Application form required for a child participating in an Inclusion Support Program delivered by a licensed ELCC family child care provider.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance
Inclusion Support Program Letter to Centres
This letter to child care centres introduces the Inclusion Support Program policy for eligibility and application process.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance
Inclusion Support Program Service Planning Request for Child Care Facilities
This form must be submitted by child care facilities to access services under the Inclusion Support Program.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Application, Families
Inclusion Support Program Staffing Grant Application
This document is a Staffing Grant Application form requesting Early Learning and Child Care funding for staff to support child(ren) participating in a Inclusion Support Program delivered by a licensed child care facility in Manitoba.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Families, Financial Assistance
Income Assistance Review
Employment and Income Assistance requires a review of the circumstances of each income assistance client.
Department/Crown:Families
Categories:Families, Financial Assistance
Income Declaration
This form is a full declaration of employment income and expenses at each month end, prior to any calculations of EIA eligibility for the upcoming month, or payment of any assistance. EIA participants are asked to forward this form with original cheque stubs and payment receipts after receiving the last income for the month.  
Department/Crown:Families
Individual Client Action Plan
This 2011 Employment and Income Assistance circular reminds staff to ensure that Client Action Plans are current, signed and given as a copy to the participant.
Department/Crown:Families
Categories:Families, Financial Assistance
individual Program Plan
This form is part of the child in care file, It describes the medical professionals that are engaged in the child life, any assessments that have been done and any changes in the child's life. It is filled out by the caseworker on agency letterhead.
Department/Crown:Families
Category:Families
Infant Less than 12 weeks of Age - Exemption Request Checklist
This form is required to request an age exemption for a child less than 12 weeks of age to attend a Manitoba licensed child care facility.
Departments/Crowns:Education and Early Childhood Learning, Families
Category:Families
Information and Application for a warrant to search for a child (CFS-23)
If there is reasonable grounds to believe a child might be in need of protection, a judge will grant this warrant to allow peace officers to search for the child.This is a statutory regulated form embedded in The Child and Family Services Regulation. This is an agency form and would not be filled out by the general public.
Department/Crown:Families
Category:Families
Information and Application to obtain a warrant to apprehend an absconded child (CFS-25)
This warrant entitles a peace officer to apprehend and return a child in care to their placement if they run away. This is a statutory regulated form embedded in The Child and Family Services Regulation. It I s a form that would only be filled out by a CFS agency and/or a peace officer.
Department/Crown:Families
Category:Families
Information Booklet Full Citizenship
An introduction to A Manitoba Provincial Strategy On Disability
Department/Crown:Families
Categories:Families, Financial Assistance, Health
Information Disclosure Statement (CLDS-SDM)
This form is completed by the substitute decision maker for a Community LIving disABILITY Services participant to provide their consent for a referral to Behaviour Psychology Services. This form also provides substitute decision maker information on Behaviour Psychology Services, their role in the service as well as information regarding confidentiality.  
Department/Crown:Families
Information for Individuals Applying for a Self-Check Mail Adult Abuse Registry Check: Checklist
The Registrar of the Adult Abuse Registry, is obtaining personal information so that the Registrar can conduct an Adult Abuse Registry check.  The Registrar will also use this information to update the Adult Abuse Registry.
Department/Crown:Families
Categories:Application, Families
Information for Internationally Educated Applicants
This document provides detailed information for an Early Childhood Educator (ECE) who was educated outside Canada (internationally-educated) on what is required to apply and become classified as a Child Care Assistant, ECE II or ECE III in Manitoba.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Certification, Education and Training, Families
Information on the Classification of early Childhood Educators and Child Care Assistants
This document provides detailed information about classification (upgrades and re-issue) of early childhood educators (ECE) and child care assistants, including the application process, education requirements, and equivalency assessments. This policy also outlines the proportion of trained professionals (ECE's) required in licensed early learning and child care centres and nursery schools in Manitoba.
Departments/Crowns:Education and Early Childhood Learning, Families
Categories:Certification, Education and Training, Families
INL1 Letter - Information Requested
Letter sent when information is required from a client.
Department/Crown:Families
Categories:Families, Financial Assistance
INL2 Letter - Information Requested 2nd Letter
Letter sent when requesting information from a client.
Department/Crown:Families
Categories:Families, Financial Assistance
Insight Evaluation Guide
This guide outlines the way in which HCMO's evaluation forms are to be administered with InSight Mentor Program participants.
Department/Crown:Families
InSight Mentor Program - Aftercare Contact Tracking Form
This form tracks contact with the InSight Mentor Program made by former participants who have graduated from the program.
Department/Crown:Families
Insight Mentoring Program: File Closure Form
This form is completed upon a participant's exit of the program, either due to graduation or other means of departure from the program.
Department/Crown:Families
Insight Mentoring Program: Getting to Know You
This is the InSight Mentor Program intake form, which is completed with new participants. Information about the participant's health, substance use, current or most recent pregnancy, and use of community services.
Department/Crown:Families
Insight Mentoring Program: Getting to Know Your Baby
This form is completed with new InSight Mentor Program participants to gather information about the participant's pregnancy and birth outcomes of their baby.
Department/Crown:Families
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