Certification of Proposed Social Services Professional (SSP)
Colorado Office of the Child's Representative
When to use this form:
OCR Contract Attorneys can use this form to certify that a Social Services Professional (SSP) satisfies the OCR's qualifications for the SSP payment rate in accordance with
OCR's SSP Policy
Your Firm Name
Your Colorado Attorney Registration Number
Proposed Social Services Professional (SSP):
SSP's Full Name
If this SSP is approved, s/he will be added to CARES. Please provide an email address for CARES which belongs to this SSP only (never used by anyone else) and is exclusive to his/her relationship with your office (e.g. firstname.lastname@example.org).
This is to ensure your office's confidential CARES data remains secure.
SSP's Unique Email Address
Confirm SSP's Email Address
I certify that this proposed SSP satisfies the Office of the Child’s Representative’s (OCR’s) qualifications for the SSP payment rate because s/he meets the following qualifications:
(Select all that apply.)
Licensed Clinical Social Worker
Licensed Social Worker
Licensed Professional Counselor
Licensed Marriage and Family Therapist
Other Relevant License
Bachelor's in Behavioral Sciences
Bachelor's in Child Development
Bachelor's in Clinical Mental Health Counseling
Bachelor's in Criminal Justice
Bachelor's in Education
Bachelor's in Family Studies
Bachelor's in Family Therapy
Bachelor's in Human Development
Bachelor's in Psychology
Bachelor's in Social Work
Bachelor's in Sociology
Other Relevant Bachelor's Degree
Master's in Behavioral Sciences
Master's in Child Development
Master's in Clinical Mental Health Counseling
Master's in Criminal Justice
Master's in Education
Master's in Family Studies
Master's in Family Therapy
Master's in Human Development
Master's in Psychology
Master's in Social Work
Master's in Sociology
Other Relevant Master's Degree
Specify the SSP's degree(s) not listed above:
Specify the SSP's
) not listed above:
If no License or Master's above:
This proposed SSP has at least two years of professional experience and direct involvement with children/and or families
(Select all that apply.)
with a department of human services.
as an educator.
as a juvenile service provider (e.g., juvenile probation, Senate Bill 94, or the Department of Youth Services).
with a residential child care facility, including residential treatment facilities and group homes, in a care or therapeutic role for children or youth.
with another social services organization, non-profit organization, or other relevant service provider.
Please identify the other social services organization, non-profit organization, or other relevant service provider and how that experience was relevant to SSP work.
Type your name and date below to further certify that you will use the proposed SSP to assist in your investigation and advocacy as as required by CJD 04-06 and as consistent with the terms of your OCR contract (including but not limited to the completion of all CBI background checks). Typed signature shall suffice as if original.
Click "Submit" to complete your request