Children Services Quarterly Statistical Report

County

Select the agency to be included in the report. This field is required.

Quarter Ending

Enter the date on which the quarter represented in the report ends. Use the format MM/DD/YYYY. This field is required.

Date Report Submitted

Enter the date the report was submitted. Use the format MM/DD/YYYY. This field is required.

Prepared by Worker

Select the worker who generated the report. This field is required.

Worker Phone

Enter the 10-digit phone number of the worker who prepared the report. This field is required.

Worker Email

Enter the email address of the worker who prepared the report. This field is required.

Worker Fax

Enter the 10-digit fax number of the worker who prepared the report. This field is required.