MARE Book Removal Form

MARE Book Removal Form
(Used only for children currently in photolisting book)

To be filled out only for a child who appears in the MARE book. Use this form when sending a Foster Parent/Relative or Recruited Family Hold form, an OTR, an FIA 5-S, or a USP to remove a child from the photolisting book.

(NOTE: All fields in RED must be complete, or form will not be accepted)

Child's Last Name:	Child's First Name:	MARE C No.:

Remove a Child From the Photolisting Because:
(please choose ONE of the following FOUR)

Child turned 18

Child deceased

Child's Federal Goal Changed to		(NOTE: we must receive a copy of the FIA 5-S, the USP, or a screen shot from CSMIS; please fax one of these to us immediately at 517-783-5904).

Child has been matched with a family	(Note:complete the following section in detail and attach Foster Parent/Relative or Recruited Family Hold form.
Adopting family's fir and last name(s):
Family's agency and worker:
Date family was identified (MM/YY):

Child Placement Information
(please choose ONE of the following SEVEN)

Child adopted by current foster family

Child adopted by relative

Child identified through MARE efforts (i.e., photolisting, videotaping, suggested match, web site)

Child identified through media recruitment Type/Date:

Child adopted by recruited family associated with agency serving child

Child adopted by recruited family from another agency

Other:

General Information About Adopting Family
(please choose the appropriate responses)

Race of Family	Status of Family

Did or Will the child move to another county as a result of this placement?

Child's Worker:

Agency:

Your email address: (e.g., you@isp.com)