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*
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Name
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Reported by**
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Any Contact info: Phone, email, Facebook, address, City
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Contacted on/by
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Mother
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Step-mother
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Grandmother
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Grandfather
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Adult Sibling
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Aunt
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Uncle
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Cousin****
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Paternal Relatives*
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Name
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Reported by**
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Any Contact info: Phone, email, Facebook, address, City
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Father
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Step-father
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Grandmother
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Grandfather
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Adult Sibling
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Aunt
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Uncle
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Cousin****
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Non-Relatives
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Name
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Reported by**
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Any Contact info: Phone, email, Facebook, address, City
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Godparent
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Neighbor
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Foster Parent
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Friend
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Minister
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Teacher
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Coach
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Other
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* 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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