RENEWAL#: Form OGC-1010.2 REV 2/19 DCF Program may request a Renewal if they would like to
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KS 67208 Grant Year (from/to) E-Mail blippe@mhasck.org 7/1/2022 6/30/2024 Phone Number 316
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Mental Health Assoc of S.C KS Renewal 1 SFY23.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/Independent Connection Inc CIL Renewal 1 and 2 SFY23.pdf
This fonn must be submitted to your DCF OGG Grant & Contract Specialist for submission through
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KS 67203 Grant Year (from/to) E-Mail cunruh@ilrcks.org 7/1/2023 6/30/2024 Phone Number
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/Independent Living Resource Center CIL Renewal 1 and 2 SFY23.pdf
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
The Department for Children and Families (DCF) has received and investigated a report of abuse, neglect, or exploitation of the involved adult named
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Adult Protective Specialist Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10350.pdf
KANSAS DEPARTMENT FOR CHILDREN AND FAMILIES
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Foster Care and Residential Facility Licensing Division
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Please complete the following and return to Kansas Department for
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Email Address
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/FCL_057_RequestForAmendment.pdf
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
Number EES-2021-ITSN-01 City, State, Zip* E-Mail 7/1/2021 6/30/2022 Phone Number Fiscal Year
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https://www.dcf.ks.gov/Agency/Operations/NOGA/Documents/KCCTO ITSN Amendment 1 and 2 FY22-24.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
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