Child Placing Agency (DCF 54) Contract Registration

This webform is used by Child Placing Agencies to supply Contract Registration Information to DCF.

The information on this webform must be completed and submitted as part of the registration process with the Division of Milwaukee Child Protective Services. A separate registration packet is required for each licensed facility. Registration materials are due by October 15 for contracts to begin on January 1 of the following year. Late or incomplete submissions may impede your ability to receive a contract by January 1.

Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes].

Upon review and approval of your registration materials, the Department of Children and Families (DCF) will issue a one-year contract that will be in effect from January through December of the following year. This contract will constitute an offer to do business with Division of Milwaukee Child Welfare (DMCW) and will stipulate mutual rights and responsibilities. Acceptance of the offer to do business will, of course, be at the discretion of the provider. NOTE: Although a contract may be granted, DMCW does not guarantee placements within any placement. All placements are determined based on the specific needs of the child.

Child Placing Agency Information

Agency Name

Licensing Capacity

Number of Homes Licensed

Level 5 Exceptional Treatment Foster Home Inquiry

Yes, our Chapter 56 license allows me to license homes as L5 OR we are in the process of becoming licensed

No, but I may be interested in becoming licensed

No, I’m not interested in becoming licensed

Enter the number of homes available to meet the needs of the specialized populations listed below

Alcohol/Drug Use/Abuse

Autism

Cognitive Disabilities

Emotional/Behavioral Disorders

Hx of Sexualized Behaviors

LGBTQIA+

Medically Needy

Teen Parenting

Transition to Adulthood

Victims of human trafficking

Victims of sexual assault (not HT)

Other (list Other type and number of homes available to meet need)

Program Information Narrative

Describe what type of administrative/case management services your agency provides to children/youth placed in your treatment foster homes and whether those services are in-house or subcontracted

Describe if there are any specialized ongoing support services offered by your agency for your licensed providers

From “Number of homes able to meet needs of Specialized Populations” above, describe how many open beds/homes your agency has to be able to meet the needs of those youth. Describe efforts your agency will be making in the next year to recruit and/or retain providers to meet the needs of these specialized populations

Describe any information you believe is important for Program Staff to know about your agency when sending placement referrals for youth

Does your facility accept placement after-hours?

Yes

What is your preferred method of contact?

Phone

Email Address

Contact Phone Number

Agency Information

Provide complete agency contact information as specified in the section below.

Agency Name

Agency Physical Address

City/Town

State/Province

ZIP/Postal Code

Agency Mailing Address (if different from above)

City/Town

State/Province

ZIP/Postal Code

Agency Telephone Number

Phone Number for Placements

Agency Fax Number

Agency Email Address

Point of Contact Name

Point of Contact Email

Point of Contact Phone Number

Fiscal Contact Name

Fiscal Contact Email

Fiscal Contact Phone Number

FEIN Number

UEI Number

You must have a valid UEI number. If you do not have one, please register at sam.gov.

UEI Number Confirmation Statements

I have checked my UEI number on sam.gov and it is valid

I understand if I do not have a valid UEI number, I will not be issued a contract until the UEI number validity has been resolved

Corporate Information (if different from facility information)

Corporation Name

Corporation Email

Corporation Telephone Number

Corporation Physical Address

City/Town

State/Province

ZIP/Postal Code

Corporation Mailing Address (if different than physical address above)

City/Town

State/Province

ZIP/Postal Code

Contract Information

Review Scope and Performance Monitoring Plan

Name of Person with Authority to Sign a DCF Contract

Direct Email of Contract Authorized Person

Telephone Number of Contract Authorized Person

(Contracts are sent to the agency as a DocuSign document, so email MUST belong to the signee.)

I have read the Scope of Services and the Performance Monitoring Plan and have included the required documentation to complete the registration packet. I understand all incomplete registration packets will not be reviewed and will be returned for completion.

Attach the required documentation

DCF-F-2583-W (N. 09/2026)
For questions about this form contact the Division of Milwaukee Child Welfare / Bureau of Research, Analytics and Programs Forms Coordinator.

Child Placing Agency (DCF 54) Contract Registration

Child Placing Agency Information

Enter the number of homes available to meet the needs of the specialized populations listed below

Program Information Narrative

Agency Information

Corporate Information (if different from facility information)

Contract Information

DCF-F-2583-W (N. 09/2026)For questions about this form contact the Division of Milwaukee Child Welfare / Bureau of Research, Analytics and Programs Forms Coordinator.

DCF-F-2583-W (N. 09/2026)
For questions about this form contact the Division of Milwaukee Child Welfare / Bureau of Research, Analytics and Programs Forms Coordinator.