Forms & Additional Information

CSA Manuals - Local Manual

  1. City of Charlottesville and Albemarle County Local Policies and Procedures for Administration of the Children's Services Act (September 2019)

CHINS Services

Provider Information

Provider Agreements

FY20

  1. FY20 Albemarle County Provider Agreement - Licensed Providers (PDF)
  2. FY20 Albemarle County Provider Agreement - Non-Licensed Providers (PDF)
  3. FY20 Albemarle County Provider Agreement - Short Form (PDF)
  4. FY20 City of Charlottesville Provider Agreement - Licensed Providers (PDF)
  5. FY20 City of Charlottesville Provider Agreement - Short Form (PDF)
  6. FY20 City of Charlottesville Provider Agreement - Non-Licensed Providers (PDF)

Family Engagement Tools

  1. Family Assessment and Planning Team (FAPT) Meetings: A guide for Parents/Guardians brochure - English (PDF)
  2. Family Assessment and Planning Team (FAPT) Meetings: A guide for Parents/Guardians brochure - Spanish (PDF)
  3. The Comprehensive Services Act (CSA) brochure (PDF)

Funding Approval Request Forms (click "Read Only" if prompted to enter a password)

  1. Individualized Family Service Plan (IFSP)
  2. IFSP Addendum
  3. IFSP Participation and Consent Form
  4. Foster Care Maintenance and Routine Foster Care Expenses Funding Authorization Form (DSS only)
  5. Emergency Services Funding Approval Request Form (Mandated FC and FCP only)
  6. Emergency Placement Funding Approval Request Form (DSS only)
  7. SPED Funding Authorization & UR Form
  8. CSA Quarterly Purchase of Service Request Checklist
  9. CSA Data Elements Sheet

Additional Forms

  1. FAPT Staffing Request Form (Word Document - electronic)
  2. CSA Consent for Release of Information Form (Word Document - print)
  3. CSA Consent for Release of Information Form - Spanish (Word Document - print)
  4. Consent for Release of Substance Abuse Services Information Form (Word Document - print)
  5. CSA Transfer Release Form (Word Document - print)
  6. CSA Termination/Discharge Form (Word Document - electronic)
  7. Need for Treatment Foster Care (Word Document - electronic)