to); Ff (Fax from); Et (E-mail to); Ef (E-mail from); Check Mark for Health
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1010.pdf
State of Kansas PPS 6180 Department for Children and Families Jul-2017 Prevention and Protection Services Page 1 of 2 Permanent Custodianship Subsidy Repayment
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Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6180.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
Notification of Grant Award (NOGA) Under Federal Grant Award Number – N/A DCF Award Number
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KS 66603-3444 Phone: (785) 506-7178 Email: jennifer.goodman@ks.gov (2) To Grantee: KVC
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KVC Family First-Strengthening Families NOGA SFY24.pdf
Kansas Department of Social and Rehabilitation Services Kansas Rehabilitation Services: Youth
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D. PROJECT DIRECTOR (NAME, TITLE, ADDRESS, TELEPHONE, E-MAIL
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Please email questions to
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https://www.dcf.ks.gov/services/RS/Documents/Mentoring RFP/REVISED_DATES_ RFP_Mentoring_Youth_with_Disabilities_10-6-11_PS.pdf
Page 1 of 19 FCL 403
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of Applicant/Licensee (exactly as it appears on the license) Telephone Number Email Address
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Surveyor’s Signature Agency Represented Email Address Date
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL 403 FFH Survey Instrument-CPA.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/HRADAC Renewal 1 and 2 SFY23.pdf
Email
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B. Type of Agency ☐Public ☐Private Non-Profit ☐Private Profit
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C. Official Authorized to Sign Application
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F. Type of Application ☐New ☐Revision ☐Continuation of Grant
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https://www.dcf.ks.gov/services/RS/Documents/OIB_AttachmentA.pdf
Chapter 2: Family Foster Home Descriptions
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Levels of Service (Level of Care/LOC
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Intensive Family Foster Home (Intensive 1 & Intensive 2
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HCBS Waiver Family Foster Home (HCBS – I/DD
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https://www.dcf.ks.gov/services/PPS/Documents/CWHandbookofServices/Placement _Standards_July_2021.pdfView duplicates
Notification of Grant Award (NOGA) Under Federal Grant Award (ALN) Number (93.472 and 93.558
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Topeka, KS 66603 Phone: 785-506-7178 Email: Jennifer.goodman@ks.gov (2) To Grantee: Kansas
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KCSL HFA Family First SFY24 NOGA.pdf