FCL 002 Rev 2/2019 Page 1 OF 1 KANSAS
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Initial application (new facility, move, or change of ownership
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CURRENT ADDRESS
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Street Address City State Zip
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_002_Individual_Background_Check_Request.pdfView duplicates
Services FC/AD NOTIFICATION OF MOVE/PLACEMENT/CHANGE PPS 5120 REV. July 2023 Page 1 of 3
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Previous Placement Name and Address
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Change of status for sibling(s) remaining in the home
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5120 .pdf
in Receiving State: Name of Resource: Address: Type of Care: Placement Change Effective Date of Change: Name of Resource: Address: Type of Care: SECTION III COMPACT
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_9000_Forms/PPS9135.doc
Acknowledgment of Referral / Change / Closure
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Address
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SECTION V Case Status Change
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☐ Court venue change (custody only / services transfer to another region
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☐ Family did not sign Family Case
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4205.docx
move to new state New Address: Child-only move to new state New Address: Reason: Family new phone/email New
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_9000_Forms/PPS9121.doc
Information: Name of Parent 1: Email Address: Cell Phone #: Name of Parent 2: Email Address: Cell Phone #: Street Address: City, State and Zip Code: County of
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5318.doc
EES Program Administrators
September 22, 2011
Page 5 of 8
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M E M O R A N D U M
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SUBJECT: Implementation Instructions - KEESM Revision #49
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Potential Resources – See Summary of Changes item
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https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/Implementation Memo Rev 49final_9-29-11.docxView duplicates
others share ideas for services and supports to address immediate safety and risk concerns
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© 2021 Evident Change
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_0F.docx
DEPARTMENT OF SOCIAL AND REHABILITATION SERVICES
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A. APPLICANT AGENCY (NAME, ADDRESS, TELEPHONE
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Font size may be 10 point
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D. PROJECT DIRECTOR (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL
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https://www.dcf.ks.gov/services/PPS/Documents/Grant_Information/SFY12FamilyResourceProjectGrantApplication.docx
does not have the right to appeal a change in policy, and therefore the matter should be
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Name Address Signature
https://content.dcf.ks.gov/EES/KEESM/Appendix/B-4 2023 FA Allotment Motion to Dismiss.docView duplicates