S-5 Sponsor Assessment - New UC Portal

Sponsor Assessment (Form S-5)

UAC Basic Information and Sponsor Demographic Information Tab

Document Type	Expiration Date	Verified by Government Agency	Picture ID

Contact Information Tab

Document Type	Date Issued	Dated Within Last 2 Months

Relationship to Child Tab

Document Type	Expiration Date	Verified by Government Agency	Picture ID

Criminal History & Background Checks Tab

Crime	Date	Length of Sentence/Detention	Location

Type	Check Required in All Cases?	Check Requested	Date Requested	Date Results Received	Results

Sponsorships Tab

Name	A#	DOB	Gender	Relationship to Child	Current Location	ORR Release Decision	Date of Discharge	Discharge Program Name

Family Relationships Tab

Name	Age	Date of Birth	Gender	Current Location	Name of Mother

Name	Age	Relationship to Sponsor

Household Tab

Name	A#	Date of Birth	Gender	Sponsor’s Relationship to Child	Current Location	Background Checks	ORR Release Decision	Date of Discharge	Discharge Program Name

Document Type	Expiration Date	Verified by Government Agency	Picture ID

Employment Tab

Care Plan Tab

Name	A#	Date of Birth	Gender	Home Address	Phone #	Relationship to Sponsor	Background Checks

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