S-5 Sponsor Assessment - New UC Portal

Services Provided to Unaccompanied Children

S-5 Sponsor Assessment - New UC Portal

Adult Contact Profile (Portal Form S-5; Path Form S-7)

OMB: 0970-0553

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Sponsor Assessment (Form S-5)


UAC Basic Information and Sponsor Demographic Information Tab

Shape2 Shape1


Shape3

Document Type

Expiration Date

Verified by Government Agency

Picture ID
















Contact Information Tab


Shape4

Document Type

Date Issued

Dated Within Last 2 Months















Relationship to Child Tab

Shape5

Document Type

Expiration Date

Verified by Government Agency

Picture ID
















Criminal History & Background Checks Tab




Shape6

Crime

Date

Length of Sentence/Detention

Location














Shape7

Type

Check Required in All Cases?

Check Requested

Date Requested

Date Results Received

Results




















Sponsorships Tab

Shape8

Name

A#

DOB

Gender

Relationship to Child

Current Location

ORR Release Decision

Date of Discharge

Discharge Program Name































Shape34 Shape32 Shape10 Shape33 Shape30 Shape31 Shape15 Shape14 Shape29 Shape28 Shape27 Shape13 Shape17 Shape16 Shape22 Shape12 Shape11 Shape26 Shape25 Shape24 Shape21 Shape20 Shape23 Shape18 Shape19 Shape9

Shape52 Shape59 Shape49 Shape48 Shape46 Shape58 Shape57 Shape42 Shape40 Shape37 Shape36 Shape35 Shape51 Shape56 Shape50 Shape47 Shape45 Shape44 Shape55 Shape43 Shape41 Shape38 Shape39 Shape54 Shape53





Shape67 Shape65 Shape64 Shape66 Shape63 Shape62 Shape60 Shape61


Family Relationships Tab

Shape68

Name

Age

Date of Birth

Gender

Current Location

Name of Mother






















Shape69

Name

Age

Relationship to Sponsor












Household Tab


Shape70 Shape83 Shape81 Shape82 Shape71 Shape80 Shape79 Shape78 Shape77 Shape76 Shape72 Shape73 Shape74 Shape75

Shape84

Name

A#

Date of Birth

Gender

Sponsor’s Relationship to Child

Current Location

Background Checks

ORR Release Decision

Date of Discharge

Discharge Program Name








































Shape85

Document Type

Expiration Date

Verified by Government Agency

Picture ID















Employment Tab


Shape86 Shape95 Shape94 Shape87 Shape91 Shape88 Shape90 Shape89 Shape93 Shape92


Care Plan Tab



Shape96

Name

A#

Date of Birth

Gender

Home Address

Phone #

Relationship to Sponsor

Background Checks


























Shape97

Alternate Adult Caregiver’s Name

Document Type

Expiration Date

Verified by Government Agency

Picture ID



















Trafficking & Fraud Tab









Flags Tab




Case Manager Assessment Tab


Certification Tab



File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
AuthorHerboldsheimer, Shannon (ACF)
File Modified0000-00-00
File Created2023-10-29

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