Social Services Report Please complete the below form within 5 days of receipt.Social Services ReportService Agency(Required)State Worker's Name(Required)State Worker's Email(Required) Child's Name(Required)Parent/Guardian's Name(Required)In order to find the best suited mentor for the child named above, please answer the following questions:How long has the child been removed from the home?(Required)Please indicate the nature of why the child was removed.(Required)Is there a plan for reunification? If so, when?(Required)Has the child ever had a psychological evaluation?(Required) Yes No When and where?If you have the results, please summarize them.Does the child have any physical/mental diagnosis? If yes, please explain.(Required)What social, academic, or personal problems does the child show in school, at home and/or with peers?(Required)In general, describe the child’s personality. Include strengths and weaknesses.(Required)If known, describe the parent-child relationship, including major areas of conflict.(Required)In what specific ways do you think a Big Brother/ Big Sister could help the child?(Required)Are there any problems the parent may offer if a Big Brother/ Big Sister is assigned to their child?(Required)Are there any problems the child may offer if assigned to a big Brother/ Big Sister?(Required)Additional Comments
