Genogram and Connections-of-Affection for Family Finding Child’s Name



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Genogram and Connections-of-Affection for Family Finding
Child’s Name ____________________________________ D.O.B _________________
Enter connections of affection past or present, and current relatives and caregivers.

If there is no place on the chart for an identified relationship, create a place for it.
Maternal Relatives*




Name

Reported by**

Any Contact info: Phone, email, Facebook, address, City

Contacted on/by

Mother













Step-mother













Grandmother













Grandfather













Adult Sibling













Aunt













Uncle













Cousin****














Paternal Relatives*




Name

Reported by**

Any Contact info: Phone, email, Facebook, address, City




Father













Step-father













Grandmother













Grandfather













Adult Sibling













Aunt













Uncle













Cousin****














Non-Relatives




Name

Reported by**

Any Contact info: Phone, email, Facebook, address, City




Godparent













Neighbor













Foster Parent













Friend













Minister













Teacher












Coach













Other












* All relationships listed include natural, adoptive and step relatives and their spouses.

** Is the youth, the adult in question or a named third party the source of this information?

****Cousins include second cousins, step-cousins, and cousins once removed.



Also see: http://www.nrcpfc.org/downloads/SixSteps.pdf)

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