State of Rhode Island

DCYF Clearance Request

Rhode Island Department of Children, Youth and Families

DCYF Web site | RI.gov | Admins

DCYF Clearance Request

WelcomeRequestReviewPaymentConfirmation

Please fill out the requested information for your DCYF Clearance Request.

Facility Information

* Facility Name:
* Has this facility submitted a request in the past?
- Yes
- No
* Mailing Address:
* Mailing City:
* Mailing State:
* Mailing ZIP Code:
Facility Phone No.:
(ex. 111-111-1111)
* Facility Email Address:

Request Type

Please indicate the request type:

Information Release

By checking this box, you attest that this facility has provided the subject with the information release. They also attest that they received authorization from the subject to submit the request to DCYF.
* Date Of Authorization:

Subject/Applicant Information

* First Name:
Middle Name:
* Last Name:
Subject/Applicant has no maiden name:
Maiden Name:
Subject/Applicant has no other alias or name:
Alias or Another Known Name:
* Date of Birth:
* Street Address:
* City:
* State:
* ZIP Code:

For technical support contact: rihelp@egov.com