Kinship Placement Suitability Assessment

1. Child Information

Full Name Date of Birth Current Living Arrangement

2. Proposed Kinship Caregiver(s)

Caregiver Name(s) Relationship to Child Contact Information Address

3. Household Composition

List all household members (name, age, relationship to caregiver)

4. Assessment Areas

Safety of the Home Caregiver’s Health (Physical/Mental) Caregiver’s Understanding of Child’s Needs Discipline and Supervision Practices Financial Stability Support System/Community Resources Willingness/Ability to Work with Agency

5. Child’s Views and Wishes

Child's Input on Kinship Placement

6. Summary and Recommendation

Summary of Assessment Recommendation Suitable for Placement Not Suitable for Placement

7. Assessor Details

Assessor Name Date of Assessment Agency/Organization