How to Apply

To apply for a Good Cause Waiver from the Department of Health and Senior Services, an individual must:

• Complete an Application for Good Cause Waiver form, MO 886-3654 (9-03). (You may click on the link above or contact the Good Cause Waiver Program by phone, toll-free, at 1-866-422-6872 to request that a packet be mailed or faxed to you.)
• If the disqualifying finding is criminal history or sex offender registry, attach criminal history record from the Family Care Safety Registry or the Missouri State Highway Patrol, and certified court document for each disqualifying offense. (If a certified court document is not obtainable, a written and signed statement from the court indicating that no such record exists must be submitted.)
• If the disqualifying finding is substantiated child abuse/neglect or foster parent denial/revocation/suspension, attach the certified investigation report from the Department of Social Services (DSS). This is approximately 10 pages long and may be obtained from the local DSS office.
• If the disqualifying finding is due to inclusion on other background check lists in the Family Care Safety Registry, attach a certified investigative report or other documentation of the incident(s) that resulted in inclusion on the list.
• Attach one sponsorship letter from a current or potential employer, training agency or school. (If you are not able to obtain a sponsor, indicate that fact, identify any potential sponsors that you approached, and submit, as a substitute, 3 reference letters from persons knowledgeable of your character and employment history who are not related to or residing with you.)
• Attach your written description of the events that took place resulting in each disqualifying offense or incident. Include what happened, how it happened, why it happened, when and where it happened, any person present at the time, and the circumstances from your point of view.
• Attach your written explanation describing why you feel you do not pose a threat or risk to the health, safety or welfare of residents, clients or patients.
• Attach copies of any professional, occupational or vocational licenses, certifications or registrations issued in Missouri or any other state. If you have ever been refused a license, certificate, or registration by any public or governmental licensing board, agency or regulatory authority, attach certified copies of the denial documents. If any license, certification or registration you hold has ever been revoked, suspended or otherwise subjected to any type of disciplinary action, attach certified copies of the revocation, suspension, or disciplinary documents.
• If you have any pending felony or misdemeanor charges, include a statement explaining the circumstances and certified copies of the charging documents for all pending criminal charges.
• If you have any allegations of child abuse, neglect or endangerment pending against you or any pending circumstances that might result in the denial, revocation, or involuntary suspension of a foster parent license or in your inclusion on the Department of Mental Health Employee Disqualification list, include a statement explaining the circumstances.
• If you have been found guilty, plead guilty or nolo contendere to an offense in any other state. Attach court documents that include the arrest record, statement of probable cause and the final court disposition.