The purpose of this form is for submission of exception request to Administrative Rules DCF 52, DCF 54, DCF 57 and exception and extension request to Administrative Rule DCF 59 to the Child Welfare Licensing Section. Completion of this form requires attaching a completed request for exception on for DCF-F-5023 Child Welfare Request or DCF-F-5085 Child Welfare Request for Exception-Age for exception requirements for licensed providers.
Request for extension for SC stays should be submitted via this form and a completed DCF-F-2601 Child Welfare Licensing Shelter Care Extension may be attached but is not mandatory. If the SC choses to submit the request on another form the SC must include, child name, child date of birth, date of placement and the reason for the extension request.
A separate form must be completed for each Exception/Extension Request
Do not submit exception requests to Administrative Rule DCF 56 via this form
You should receive an automated email response within 10 minutes of submission of this form. If you do not receive this response please notify licensing staff by emailing firstname.lastname@example.org.