Form for Newcomers requesting additional information for benefit assessment.

Form to be completed to establish a private support agreement between a payer and debtor 

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. 

Application and Guidelines on how to apply for Proposal Development Funding.

Protocol to ensure the smooth and positive transition of children with additional support needs into the school system.

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.

This internal referral form for behaviour psychology services is completed by Community Service Workers at Children's disABILITY Services and Community Living disABILITY Services.

This form is used by child care centres to add, modify or remove employee information from facility employee records.

This record must be updated when there are any new residents, licensees, overnight or support staff in the home. 

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. 

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.

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.

 This form allows an adoptive parent to share information on their adoptive child with their birth parents.

Form required by licensed child care facilities to register for access to the Child Care Online system.

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

Refer to CMHA for the now defunct Parent Wellness Initiative (PWI)

New Key, Replacement, when lost, change of tenant or for contractors

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).

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.

Form required by child care centres and nursery schools to apply to renew a licence.

Form required by family and group child care homes to apply to renew a licence.

Form required by an occasional child care centre to apply to renew a licence.

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

Form required to apply for the Rent Assist benefit for people who are not receiving EIA benefits. To be completed by the applicant. 

Non-EIA Rent Assist Policy Manual

This form gathers information about rental arrangements made between a tenant who is an EIA participant and the landlord. 

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.

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).  

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

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

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.

This letter outlines the financial reporting requirements of licensed nursery schools.

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.

Request for information from MEP

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.

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.

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.

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.

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

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.

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.

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.

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.

This form is to be completed by operators when requested by Residential Care Licensing (RCL).

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. 

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.

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.

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.

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.

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.

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.

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.

Authorization form for residential care rate.

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.

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. 

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. 

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.  

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.

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. 

This updated letter verifies information about the participant so that RBC may cash the cheque.  

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. 

It is the policy and program manual for The Rural Home Ownership Program

Letter to advise on funds for school supplies.

Schedule "A" template to complete and attach to Service Purchase Agreements between Manitoba and a Service Provider summarizing essential terms and expectations.

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.

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.

Web page providing access to the Science of Early Childhood Development resources.

Employment and Income Assistance form letter advising client of an approved security deposit advance.

This tool will assist you in determining if a worker is an employee or a self employed individual.  

Self-report form to be completed voluntarily for to apply for benefits under the EIA persons with disabilities category.

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.

This form is to be used by service providers to give feedback on how their programming is working for the FASD population they serve.

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.

Form to be completed to request Special Needs.

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. 

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.

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.   

This document decribes the requirements for supervision of napping infants in Manitoba's licensed early learning and child care facilities.

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.

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.  

Taxi invoice

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. 

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".

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. 

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.