MISSOURI DEPARTMENT OF SOCIAL SERVICES CHILDREN’S DIVISION ADOPTION STAFFING DECISION WORKSHEET
Adoption Staffing Facilitator Name	Date of Meeting
Child’s Name	DOB	Child’s Name	DOB
Families Presented	Phone Number	Residence County
Staffing/Decision Making Team – List all team members and check if present for family selection meeting.
Team Member Name	Signature	Role	Present
Family Selected – Name of Family Selected: Explain why this family was selected using identified criteria in Section 4 Chapter 9:
Can the selected family adopt without Adoption Subsidy? Yes No Unknown
1st Alternative Family:
2nd Alternative Family:
When a consensus is not met, the team should document in the space below the specific reason as to why and plan to reconvene for another staffing for the specific child(ren)/sibling group to arrive at a final recommendation of the families considered. This process should be repeated as often as necessary until the child is placed for adoption. Family Not Selected-Reason Consensus Not Obtained: