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Client Forms and JSSA Publications Client Forms and JSSA Publications

Please print, complete and bring all applicable forms to your first JSSA appointment. Some forms are in Microsoft Word. Save the form to your computer and complete. Thank you.

General Forms for ALL Clients
Notice of Privacy [PDF]
Client Rights and Responsibilities
Release of Information
Subsidized Fee Requests

Adoption Specific Forms
General Adoption Forms (All applicants must complete.)
Married/Couple Applicant Adoption Forms 
Single Applicant Adoption Forms

Child/Teen Specific Forms
Custody Dispute Agreement
Child's History Questionnaire
Family Psychiatric History
 

Employment and Careers Specific Forms
For career counseling appointments, please complete the Career Counseling Intake Form  and e-mail to careerinfo@jssa.org prior to your first appointment. For Job Search Groups and Library and Community Workshops, complete, print and bring the form with you. Thank you.

Career Counseling Intake Form – 2-page form
Job Search Groups – Registration Form
Library/Community Workshops

Human Resources Specific Forms
Employment Application

Social Skills Group Screening Forms
To apply for consideration in one of our social skills groups, either call Intake at 301-816-2633, or  select Social Skills Group Screening Form, complete, and email to contactus@jssa.org or fax to (301) 468-1862. Thank you.

Social Skills Group Screening Form for Children and Young Adults
Social Skills Group Screening Form for Children and Young Adults [PDF]

Volunteer Forms
Volunteer Application

For more information, please call: 301-838-4200 in Maryland, or 703-204-9100 in Northern Virginia or send us an email inquiry.
 

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