Level 5 Foster Form Submission Portal

The purpose of this portal is to submit documents for a Level 5 Exceptional Treatment Foster Homes. Submission through this portal will securely send materials to the DCF Level 5 Exceptions Panel. Please select the appropriate drop down for the form that is being submitted.

Application for the Certification and Child Placement for a Level 5 Home

The purpose of this portal is to submit the required information for the the Application for Certification and Child Placement for a Level 5 Home. Supplemental supporting documents must be uploaded as an attachment.

Provider Name
Submitter Name
Application Type

Application Attachments

Program Description Attachments

Staff Attachments

Communication Attachments

Attachments for Each Child in a Level 5 Foster Home

Incident Report in a Level 5 Home

As a Licensing Agency, use this portal to report a serious incident under DCF 56.06. This satisfies the requirement under DCF 56.06(3) that states a licensing agency shall immediately notify the department exceptions panel of any serious incident reported in this section that is reported by a foster parent of a Level 5 foster home.

Provider Name
Submitter Name
Unlimited number of files can be uploaded to this field.
500 MB limit.
Allowed types: pdf, docx.

Pre-approval to Begin Child Specific Planning for a Level 5 Foster Home

The purpose of this portal is to notify the DCF Exceptional panel that a placing agency is considering development of a Level 5 Treatment Foster Home for a specific child. This is the first step in the planning process for a Level 5 Treatment Foster Home and/or placement of a child in this home. The pre-approval form must be completed and subsequently approved by the DCF Exceptional Panel giving placing agencies approval to move forward with the full application and planning process to develop a Level 5 Exceptional Treatment Foster Home for placement of a specific child.

Provider Name
Submitter Name

Application for Child Specific Respite Services Existing Level 5 Foster Home

The Application for Child Specific Respite Services Existing Level 5 Foster Home form fulfills the requirements of DCF 56.14(7)(m) for making a respite request to the DCF Level 5 Exceptions Panel. A Level 5 foster home may only provide respite care to a child who was previously placed in the home, a child specifically identified and approved by the Department on a planned basis, or a child who has needs agreed to by the Department. The form should be submitted to the DCF Level 5 Exceptions Panel when requesting approval from the Department for child specific respite services in an existing Level 5 Foster Home. Personal information you provide may be used for secondary purposes [Privacy Law, s. 15.04(1)(m), Wisconsin Statutes].

Provider Name
Submitter Name