Grandparent as Caregiver Family Assessment
Family Information
Grandparent Name(s)
Relationship to Child(ren)
Primary Address
Contact Number
Names and Ages of Child(ren) in Care
Background Information
Reason for Caregiving
Duration of Current Living Arrangement
Legal Custody Status
Informal
Legal Guardianship
Adoption
Other
Family Strengths
Describe strengths and positive supports within the family
Challenges and Needs
Current challenges (e.g., financial, health, support)
Identified needs or services
Health and Well-being
Physical health of caregiver(s)
Emotional/mental health of family members
Support Systems
Family, friends, or community support
Current participation in programs or services
Additional Notes or Comments