Child and Adolescent Needs and Strengths (CANS)
Use of form: This form is used to request an amendment to an existing adoption assistance agreement under s. 48.975(4)(b)1. Wis. Stats. when the adoptive parent(s) believe there has been a substantial change in the special care needs of the child.
Instructions: Wisconsin Statutes, s. 48.975(4)(b)1 requires the Department to determine “… whether there has been a substantiated report of abuse or neglect of the child by the adoptive or proposed adoptive parents…” Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)m), Wisconsin Statutes. Provision of your social security number (SSN) is voluntary; not providing it could result in an information processing delay.
Complete a separate form for each child for whom you are requesting an adoption assistance amendment. Confirmation by an appropriate professional must be submitted with this form to support the characteristic(s) identified. Dates on documentation must be no earlier than 30 days prior to the date parent contacted the Department for an amendment.
List all Legal Names Since Placement of Child
Indicate Specific Years
