4 th Floor Topeka, KS 66603 Email: darcy.hoke@ks.gov (2) To Grantee: Kansas Child Care
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KS 66502-2912 Phone: (785) 532-7197 Email: pkeating@ksu.edu Kansas Child Care Training
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KCCTO WFD NOGA FY23.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
PRES ENTED TO: SENA TE WA YS & MEA NS SUBCOMMITTEE FE B. 1 1 , 2 0 2 1
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• Kansas Department for Human Services Overview and Budget Summary • Department for Children and Families Overview
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https://www.dcf.ks.gov/Agency/Testimony/Documents/2021/DCF Agency Overview SWAM 21 Session Final.pdf
Consumer’s work skills, conditions, preferences and interest
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(Recommend other pertinent consumer information be shared with the provider
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Provider Contact Name: Phone: Email
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https://www.dcf.ks.gov/services/RS/Documents/service_descriptions/Contracts/Section 11 Part-24_Service_referral_form.pdf
State of Kansas Department for Children and Families Prevention and Protection Services Permanent Custodianship Change in Status Form PPS 6170 REV 01/14 Page 1 of
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Email address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6170.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