Rev. 11/18 KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
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Foster Care Licensing and Background Checks Division PO BOX 1424 ● Topeka, KS 66601-1424 500 SW Van Buren St ● 2nd
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Email Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_411_Fingerprint-BasedCheck.pdf
Items that RS will fill in and will remain unchanged for the duration of the grant year
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City, State and Zip code (A5
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Items Grantee must fill in monthly
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https://www.dcf.ks.gov/services/RS/Documents/CIL RPF/Attachment_F4_Monthly_Fiscal.pdf
RENEWAL#: ': DCF Program may request a Renewal if thay would /ilea lo ,_ a ,nnt for an addHlonal
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Agency: Street Address* City, State, Zip* E-Mail Phone Number Fax.Number jconnections to
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Connection to Success Renewal 1 FY23.pdf
State, Zip* Grant Year (from/to) E-Mail 7/1/2022 6/30/2024 Phone Number Fiscal Year SFY23
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This form must be submitted to your DCF OGC Grant & Contract Specialist for submission through
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/International Rescue Committee IRC Renewal 1 SFY23.pdf
Part II: Narrative Section 1: Goals, Objectives and Activities - Screen 2
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Specify the objectives to be achieved and the time frame for achieving them
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Each CIL or IL service provider is
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https://www.dcf.ks.gov/services/RS/Documents/State Plan for Independent Living 2014-2016/Text alternative for table 1.2.pdfView duplicates
Foster Care and Residential Facility Licensing Division
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APPLICATION FOR LICENSE TO OPERATE A STAFF SECURE FACILITY
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Strong Families Make a Strong Kansas
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Email Address
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I/We plan to serve the
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_751_ApplicationUseForStaffSecureFacility.pdf
IZdi{iiis Dq>.ltll!WlllfwLhi!t!rc-n a111!bun1l11:, 11
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This form must be submitted to your DCF OGG
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Agency: Street Address* City, State, Zip* E-Mail Phone Number Fax Number Between Kansas
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Resource Center for Independent Living CIL Renewal 1 and 2 SFY23.pdf
*physical address required, including 9-digit zip code
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This grant shall remain in effect, subject to the terms and conditions stated in the original Notification of Grant
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KCCTO ITSN Renewal 1 and 2 FY22-23.pdf
**A copy of any previously approved Renewal(s) and/or Amendment(s), as well as a NEW FFATA form, NEW Debarment Memorandum and NEW Tax Clearance Certificate must be included with this
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Children's Advocacy Center of Kansas Inc. Renewal 1 and 2.pdf
Agency: Street Address* City, State, Zip* E-Mail Phone Number Fax Number Between Kansas
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Alphapointe OIB Renewal 1 and 2 SFY23.pdf