Effective February 20, 2017, the new Universal Application and Placement Referral Form serves as the singular document for RBWO Program Designations requests, Specialized Foster Care requests and placement referrals. It replaces the RBWO Match Screening Summary (MSS), RBWO Program Designation and Waiver Application, and Specialized Foster Care Per Diem Application.

All requests will continue to be submitted here on GA+SCORE. Click on the State Office CCTU link for further instructions and guidelines. The Universal Application and Placement Referral Form needs to be completed prior to the online submission process.

• Memorandum
• Universal Application and Placement Referral Form (rev. 03/2023)

A copy of this memorandum and form will be placed in the Georgia SHINES Help Menu in the Placement folder for future reference. If you have any questions, please contact James Kizer at james.kizer@dhs.ga.gov.