Group Home (DCF 57) Contract Registration

This webform is used by Group Homes 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.

Program Information Narrative

From “Programming Offered for Specialized Populations” above, describe what services your program offers to youth and families enrolled in your programming, if applicable. The information provided will assist the Placement Referral Unit and the Contracted Case Management Agencies with sending appropriate placement referrals to your agency

Describe what general services your program offers to youth and families enrolled in your programming, and what each youth/family can expect to receive

Describe your staffing levels and child to staff ratios. Include details of your plan to add staff for emergency situations and to meet any special needs of the children, including your willingness to meet the special needs of any children

Describe any information you believe is important for Program Staff to know about your facility 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

Facility Information

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

Facility Name

Facility Physical Address

City/Town

State/Province

ZIP/Postal Code

Facility Mailing Address (if different from above)

City/Town

State/Province

ZIP/Postal Code

Facility Telephone Number

Phone Number for Placements

Facility Fax Number

Facility 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 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 anything that may help DCF review this submission

DCF-F-2501-W (N. 09/2026)
For questions about this form contact the Division of Milwaukee Child Welfare / Bureau of Research, Analytics, and Programs Form Coordinator.

Group Home (DCF 57) Contract Registration

Facility Licensing Information

Program Information Narrative

Facility Information

Corporate Information (if different from facility information)

Contract Information

DCF-F-2501-W (N. 09/2026)For questions about this form contact the Division of Milwaukee Child Welfare / Bureau of Research, Analytics, and Programs Form Coordinator.

DCF-F-2501-W (N. 09/2026)
For questions about this form contact the Division of Milwaukee Child Welfare / Bureau of Research, Analytics, and Programs Form Coordinator.