Title ORR-4 Regugee and Entrant Unaccompanied Minor Progress Report

DEPARTMENT OF HEALTH AND HUMAN SERVICES Form Approved

Office of Refugee Resettlement OMB No. 0970-0309

REFUGEE AND ENTRANT UNACCOMPANIED MINOR PROGRESS REPORT
SECTION I - IDENTIFYING DATA
1. Name of the minor (Family - Middle - Given)				2. Date of Birth (Mo. - Day - Year)		3. Sex			Alien No./ HHS Tracking No.
SECTION II - PERSONAL FUNCTIONING OF THE CHILD				5. Date minor entered the U.S. (Form I-94)/ Date on ORR eligibility letter for trafficking minors or date asylum was granted.					6. Local Provider Agency Case No.
1. Education Information a. Indicate the minor's current grade level at school
b. Check the appropriate box below for the current grade level of schooling and provide the requested information.
	Elementary Is the minor in a regular school program? Yes No Secondary In which kind of program College bound Vocational Business is the minor enrolled?
	Postsecondary Indicate estimate date and type of degree
	Not in school Please indicate
	c. Has the minor required and received any educational remedial services during the Yes No reporting period?				If "Yes" specify
	d. For those minors 14 years and older: Has the minor obtained any educational or vocational skills, certificates, or diplomas Yes No (including GED) since the last reporting period?				If "Yes" specify
2. Caseworker/Provider Assessment Assess the minor's functioning in the following four areas. For purposes of this item, adequate is defined as functioning at the minimal level considered normal for a minors age group and which, if continued, should lead to full adjustment and self-sufficient emancipation.							Better Than Adequate			Adequate	Not Adequate
					English Language Skill
					Education (Other than English)
					Social Adjustment
					Health Condition
SECTION III - FAMILY REUNIFICATION DATA
Family reunification data for either parental or relative reunification. Describe current efforts to reunify the minor with his or her Parents. Include any, even partial, family reunification information, such as names, addresses, phone numbers, etc.
SECTION IV - FORM COMPLETION INFORMATION
Form completed by - Name			Title					Phone No. (Include Area Code)
Agency			Address
The signature of either the supervising State Child Welfare Agency representative or provider agency representative is required.
Signature								Date

FORM ORR-4 (07/31/2009) DISTRIBUTION: White--Office of Refugee Resettlement-HHS; Pink--Originator; Blue--State Agency.