DATE

NAME
ADDRESS
CITY STATE ZIP

RE: Licensee Name
License Number

Dear :

A(n) (initial evaluation, renewal evaluation, special evaluation) of your foster home was completed on (date). A copy of the report that summarizes the findings of the (initial evaluation, renewal evaluation, special evaluation) is attached to this letter. Based on the findings, we are recommending to the Bureau of Children and Adult Licensing that your foster home license be (denied, revoked, or not be renewed).

If the Bureau of Children and Adult Licensing supports our recommendation, you will be notified of any right to appeal the decision by the Bureau of Children and Adult Licensing.

You have the right to have your written response included as an attachment to the report identified above. Please forward a copy of any written response to (name of certification supervisor) at (agency name and address).

Sincerely,