Intact Family Services Child Care Referral Form Completed Form Examples and Samples

View practical examples and samples of the Intact Family Services Child Care Referral Form. Learn how to accurately complete this form with our guided templates and data extraction insights.
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Example of a completed Intact Family Services Child Care Referral Form

Intact Family Services Child Care Referral Form Example

How this form was filled:

This example demonstrates how an AI can parse an unstructured caseworker email to extract relevant household and case data for the Intact Family Services Child Care Referral Form. The AI successfully identified administrative details, parental contact information, and details for multiple children, mapping them precisely to the corresponding form fields.

Source document used: Caseworker Referral Email

From: Sarah Jenkins, DCFS Specialist ([email protected])
Sent: Tuesday, February 17, 2026 9:15 AM
To: Child Care Assistance Intake
Subject: Referral for Intact Family Services: Maria A. Garcia

Hello team, I am writing to submit a child care referral for the Garcia family, currently under our intact services caseload (Case #CY-998234-X). We are expecting to close this case on July 31, 2026, provided progress continues at the current pace.

The primary applicant is Maria A. Garcia, residing at 4422 W. Belden Ave, Chicago, IL 60639. She can be reached on her daytime line at 312-555-0198 or via her cell at 773-555-0122. Her email address is [email protected].

We are requesting care for her children. The oldest is Garcia, Elena, born 05/12/2018 (daughter). She is in school, but needs after-school care until the end of our case. Next is Garcia, Mateo, born 11/20/2020 (son). We also have Garcia, Sofia, born 03/14/2022 (daughter). Finally, there is the youngest, Garcia, Leo, born 09/05/2024 (son). All children are currently residing with the mother. Please let me know if you need any additional documentation for these four siblings to finalize the child care vouchers. Thanks for your support.

Information used to fill out the document:

  • Caseworker Info: Sarah Jenkins, [email protected], 312-555-0198
  • Case Info: CY-998234-X, Closing 07/31/2026
  • Applicant: Maria A. Garcia, 4422 W. Belden Ave, Chicago, IL 60639
  • Contact Details: Daytime: 312-555-0198, Cell: 773-555-0122, Email: [email protected]
  • Children: Elena (2018), Mateo (2020), Sofia (2022), Leo (2024)

What this filled form sample shows:

  • Automatic extraction of unstructured contact information
  • Normalization of names (e.g., converting 'Garcia, Elena' to 'Elena Garcia' for sorting)
  • Deduplication and mapping of multiple phone numbers to specific fields
  • Handling of date-based case closing calculations
  • Smart detection of child hierarchy and relationship status

Form specifications and details:

Form Name: Intact Family Services Child Care Referral Form
Complexity: Multi-child household with distinct contact fields
Primary Use Case: Social services administration
Extraction Accuracy: High - identifies specific case numbers and dates from prose
Categories: CAR forms, child care forms, referral forms, L.A. Care forms
Created: May 25, 2026 10:42 PM
Example of a completed Intact Family Services Child Care Referral Form