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An employment services agency can use either the DHS form on the list below or an alternative form from their county or tribe.

Referral forms

· Diversionary Work Program/Minnesota Family Investment Program Employment Services Referral (DHS-3166-ENG) (PDF). A paper version is not necessary, if the electronic status update is on WF1.

· Family Violence Referral (DHS-3323) (PDF).

Requests for information

· Request for Verification of School Attendance/Progress (DHS-2883-ENG) (PDF).

· Request for Medical Opinion (DHS-2114-ENG) (PDF).

Assessment forms

· DWP/MFIP Observation Checklist (DHS-3483) (PDF).

· MFIP Self-Screen Scoring Form (DHS-3482A-ENG) (PDF).

· MFIP Special Learning Needs Scoring Form (DHS-3504A-ENG) (PDF).

Other forms

· Minnesota Family Investment Program (MFIP) Education Activity Log (DHS-4209N-ENG) (PDF).

· Authorization for Release of Employment Information (DHS-2146-ENG) (PDF).