Division of Children and Family Services - AR Human Services 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the guardian's full name(s) and contact information in the designated fields. Ensure accuracy as this information is crucial for communication.
3. Next, fill in the child's full name, social security number, and date of birth. This section is vital for identifying the child under guardianship.
4. Indicate whether this is an initial or amended agreement by selecting the appropriate option. If it's an amendment, provide details about previous agreements.
5. Review the provisions of agreement section carefully. Acknowledge your roles and responsibilities as a guardian by checking each box that applies.
6. Complete the financial assistance details, including monthly cash payment amounts and medical coverage options. Make sure to consult with relevant parties if needed.
7. Finally, sign and date the document at the bottom. Ensure all signatures are collected before submitting it back to DCFS.

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