Department of Family and Children S Services

Santa Clara County

Social Services Agency

Department of Family and Children’s Services

ADOPTION FINALIZATION CHECKLIST

Documentation The following documentation is needed from the primary Social Worker in order to begin the adoption finalization process:

Child’s Name: / Number of File Volumes:

366.26 Minute Orders

Orders under Welfare and Institution Code Sections 366.26, 727.3, 727.31 (JV 320 - Example), if available

Santa Clara County Family Social and Medical History form for Birth Parents (SCZ 222)

Photos (Birth Family)

Correspondence from birth parents to the child (if applicable)

Child’s placement history information

Two certified copies of child’s birth certificate

Birth and medical records (child’s)

Dental reports (when relevant)

Other medical reports (e.g. Health Contact Forms, Health and Education Passport, PHN’s assessment, immunization records)

Psychological Evaluation/Assessment

Treatment/counseling progress reports (e.g. therapist’s letter, FFA reports)

Scholastic information (e.g. school reports, IEP)

Any other pertinent reports

ICPC reports

Additional Information

Date parental rights terminated: / Court Department:
Termination of parental rights appealed? Yes No
Paternity established? Yes If yes, date established: / No
Were parental rights of all alleged, presumed, John Doe fathers (with the right spelling) terminated? Yes No
Note: Birth parent’s and child’s name need to match the birth certificate
Has Adoption Home Study been completed? Yes No
Comments:
Was application made for Victim Witness funds? Yes No
If yes, claim #: / If no, please submit application.
Was ICWA notice sent? Yes If yes, attach a copy of initial ICWA noticing / No
Did Court find that ICWA applies? Yes If yes, date of finding: / No
Is the child Title IV eligible? Yes No
If yes, current amount of basic AFDC-FC rate: / $ / SCI Rate: / $
If no, what type of other funding does caregiver receive and how much (i.e. SSI, SSA,
CalWORKs, etc.)? Type: / Amount: / $
Dual Agency rate? Yes If yes, rate: / $ / No
Dual Agency Supplement? Yes If yes, amount: / $ / No
Eligibility Worker: / Phone #:
Primary Social Worker: / Phone #:
Social Work Supervisor: / Phone #:
G:\template\forms\SCZ 93.doc
File: 5th Fastener, Left - Under / Adoption Finalization Checklist – Rev. 8-26-09
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