Care Closet Request Form

This form is intended for foster parents, case workers, placement agencies, kinship caregivers, and approved support professionals requesting assistance for children in transition.

Case Manager Name

Case Manager Email

Case Manager Phone Number *

Case Manager Email *

Child Information

Child First Name & Last Initial
Age
Gender
Race/Ethnicity
Shirt Size
Pants Size
Shoe Size
Underwear Size

Urgency of Need

Immediate (24–48 hrs)

Within 1 Week

General Need

Placement Type (copy)

Emergency Placement

Foster Home

Kinship Placement

Group Home

Reason For Request (copy)

New Placement

Placement Disruption

Reunification Support

Other

Personalization (Optional)

Favorite Color
Interests or Hobbies
Any Sensory Needs or Preferences
Health / Practical Needs:
Allergies (if any)
Skin Sensitivities
Hair Type / Hair Care Needs

Preferred Pickup Location

Date Needed By

I confirm this request is for a child currently in care or in need of services.

Signature (Name + Date)