Tell us about the child you are concerned about Name Unknown?

First Name

Middle Name

Last Name

Suffix

Date Of Birth

Age (years)

Age (months)

Gender Select Gender Female Male Unknown

Race Select Race Asian Black / African American Declined To Identify Native American / Alaskan Native Hawaiian / Pacific Islander Unknown Unknown Due To Abandonment White

Ethnicity Select Ethnicity Declined to Identify Hispanic Central American Hispanic Cuban Hispanic Dominican Hispanic Mexican Hispanic Other Hispanic Puerto Rican Hispanic South American Hispanic Spanish Descent Not Hispanic Unknown Unknown Due To Abandonment

Other Race Select Other Race Asian Black / African American Declined To Identify Native American / Alaskan Native Hawaiian / Pacific Islander Unknown Unknown Due To Abandonment White

Language Select Language Albanian Arabic Armenian Bengali Bulgarian Cantonese Chinese Croatian Czech Danish Dutch English Flemish French German Greek Hebrew Hindi Icelandic Iranian Italian Japanese Khmer Korean Lao Latvian Lithuanian Malay-Indo Nonverbal Norwegian Other Persian Polish Portuguese Punjabi Romanian Russian Serbian Serbo-Croatian Sign Language Slovak Slovenian Spanish Swahili Swedish Tagalog Tamil Thai Ukrainian Unknown Urdu (P&I) Vietnamese Yoruba

Is this child an active military dependent? Is this child an active military dependent? Yes No Unknown

Do you have knowledge of how the child functions on a daily basis, socially, emotionally, physically, and cognitively?
Do you have knowledge of how the child functions on a daily basis, socially, emotionally, physically, and cognitively? Yes No Unknown