Division of Children, Youth and Families
When Child Protective Services (CPS) receives an allegation of child abuse or neglect by a parent, guardian or custodian
and a report is taken, Arizona law requires CPS to conduct an investigation and provide you with information about your
rights both verbally and in writing. The following complaint or allegation concerning your family is currently under
This notice is to inform you that:
• CPS has no legal authority to compel or make you cooperate with the investigation or to accept services, but it is our
hope that by working together we can find solutions to ensure that your child (or children) is safe and that your family
has what it needs.
• CPS has a duty to proceed with the investigation even if you decide not to cooperate to ensure that your child (or
children) is safe, although we would prefer to carry on with the investigation with your support.
• Your refusal to cooperate with the investigation or services offered does not in itself form a basis for CPS to take
temporary custody of your child (or children), unless it is clearly necessary to protect your child (or children) from
abuse or neglect.
• CPS has the authority to petition the Juvenile Court for a determination that your child (or children) is dependent and in
need of protection.
• You have the right to provide written, telephonic or verbal responses to the allegation, including any documentation,
and to have the information considered in determining whether your child (or children) is in need of protective services.
• You need to know that anything you say or write can be used in a court proceeding.
• You need to know that anything you say may be included in CPS’ report of the investigation.
• You need to know that any written response that you provide, including any documentation, will be included in the
CPS case record.
• You need to know that any information that you provide in response to the complaint or allegation(s) will be
considered during the investigation.
• You have the right to appeal determinations made by CPS about the results of the investigation and will be notified in
writing of these results and how to appeal.
• You have the right to:
• Request and participate in a Mediation Program in the Attorney General’s Office. The telephone number for the
Mediation Program in Phoenix is (602) 542-7767, and in Tucson, (520) 628-6782. The Mediation Program may be
used to settle disputes that arise among families, CPS, and others concerned with the welfare of children.
• File a complaint with the Arizona Ombudsman-Citizens Aide. The telephone number in Phoenix is (602) 277-7292,
and statewide toll-free is 1-800-872-2879. The Ombudsman-Citizen Aide office is available to handle inquiries,
concerns and complaints about agency actions, including CPS.
More information about CPS and your parental rights are outlined in the pamphlet, “Guide to Child Protective Services”
that I am leaving with you today.
By signing this form, you are acknowledging that I have reviewed the information contained in this notice with you.
Yes No Parents were asked about Native American/American Indian heritage.
See reverse for EOE/ADA disclosure.
Equal Opportunity Employer/Program Under Titles VI and VII of the Civil Rights Act of 1964 (Title VI & VII), and
the Americans with Disabilities Act of 1990 (ADA), Section 504 of the Rehabilitation Act of 1973, and the Age
Discrimination Act of 1975, the Department prohibits discrimination in admissions, programs, services, activities, or
employment based on race, color, religion, sex, national origin, age, and disability. The Department must make a
reasonable accommodation to allow a person with a disability to take part in a program, service or activity. For
example, this means if necessary, the Department must provide sign language interpreters for people who are deaf, a
wheelchair accessible location, or enlarged print materials. It also means that the Department will take any other
reasonable action that allows you to take part in and understand a program or activity, including making reasonable
changes to an activity. If you believe that you will not be able to understand or take part in a program or activity
because of your disability, please let us know of your disability needs in advance if at all possible. To
request this document in alternative format or for further information about this policy, contact 602-542-0220;
TTY/TDD Services: 7-1-1.

Please Make Note

Please make note that I, Jessica Lynn Hepner the creator of What Every Parent Should Know, is not giving legal advice. I am not a lawyer. I am giving you knowledge via first hand experiences.

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Save A Life by Angie Kassabie

Save A Life by Angie Kassabie
I URGE ALL MY FRIENDS TO READ & SHARE THIS; YOU COULD SAVE A LOVED ONES LIFE BY KNOWING THIS SIMPLE INFORMATION!!! Stroke has a new indicator! They say if you forward this to ten people, you stand a chance of saving one life. Will you send this along? Blood Clots/Stroke - They Now Have a Fourth Indicator, the Tongue: During a BBQ, a woman stumbled and took a little fall - she assured everyone that she was fine (they offered to call paramedics) ...she said she had just tripped over a brick because of her new shoes. They got her cleaned up and got her a new plate of food. While she appeared a bit shaken up, Jane went about enjoying herself the rest of the evening. Jane's husband called later telling everyone that his wife had been taken to the hospital - (at 6:00 PM Jane passed away.) She had suffered a stroke at the BBQ. Had they known how to identify the signs of a stroke, perhaps Jane would be with us today. Some don't die. They end up in a helpless, hopeless condition instead. It only takes a minute to read this. A neurologist says that if he can get to a stroke victim within 3 hours he can totally reverse the effects of a stroke...totally. He said the trick was getting a stroke recognized, diagnosed, and then getting the patient medically cared for within 3 hours, which is tough. >>RECOGNIZING A STROKE<< Thank God for the sense to remember the '3' steps, STR. Read and Learn! Sometimes symptoms of a stroke are difficult to identify. Unfortunately, the lack of awareness spells disaster. The stroke victim may suffer severe brain damage when people nearby fail to recognize the symptoms of a stroke. Now doctors say a bystander can recognize a stroke by asking three simple questions: S *Ask the individual to SMILE. T *Ask the person to TALK and SPEAK A SIMPLE SENTENCE (Coherently) (i.e. Chicken Soup) R *Ask him or her to RAISE BOTH ARMS. If he or she has trouble with ANY ONE of these tasks, call emergency number immediately and describe the symptoms to the dispatcher. New Sign of a Stroke -------- Stick out Your Tongue NOTE: Another 'sign' of a stroke is this: Ask the person to 'stick' out his tongue. If the tongue is 'crooked', if it goes to one side or the other that is also an indication of a stroke. A cardiologist says if everyone who gets this e-mail sends it to 10 people; you can bet that at least one life will be saved. I have done my part. Will you?

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