Identifying Information: Name of Parent 1: Email Address: Cell Phone #: Name of Parent 2: Email Address: Cell Phone #: Street Address: City
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How did they deal with ended
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5318.doc
Department for Children and Families IS-4315
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Email: Gender
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TANF $ per month Medical SSI
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Child Care Plan in Place SSDI $ per month
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CN Email
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https://content.dcf.ks.gov/EES/KEESM/Forms/IS-4315EmploymentServicesReferraltoVocationalRehabilitation08-21.docxView duplicates
☐ Attach and email all forms to the grantee/provider, regional Family First mailbox and your
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Use the email subject line: FF_county abbreviation_Lastname_Firstname_4310_Closure
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS4310.docx
Pre-ETS Email and Phone Number
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Student’s email
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Parent/Guardian’s email
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Student’s accommodations/auxiliary aid needs or food allergies if applicable
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If you do not accept the referral the
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https://www.dcf.ks.gov/services/RS/Documents/service_descriptions/EmpowerME_referral2.docx
Mother’s right’s terminated/relinquished? Yes No Father’s right’s terminated/relinquished? Yes No
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Anticipated date of child’s high school graduation
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6155.doc
(if different from above): Father’s name
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Name: Address: Phone Number: E-Mail Address: Section VI: Additional Information
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(Email to DCF 30 days prior to the end of aftercare
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_5M.doc
If your child is attending school virtually either full or part-time for the 2020-2021 school year
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EES Email
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Save and attach to an email to the office serving the county where you live
https://content.dcf.ks.gov/EES/KEESM/Implem_Memo/Instructions for Submitting Child 2020 School Schedule Form.docxView duplicates
with a 10 day time limit
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Phone Call/text/e-mail to reschedule appointment or assignment: check the box if the CN attempted to call/text/e-mail the client and the date of the attempt
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https://content.dcf.ks.gov/EES/KEESM/Appendix/E-5PenaltyChecklistForCN03-19.docxView duplicates
Send a scan of the form to the EBT Unit as an attachment to an e-mail to DCF.EBTMAIL@ks.gov
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portions of the form are completed, email the completed form to the Administrative Office
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https://content.dcf.ks.gov/EES/KEESM/Forms/ES-3142EBT_Ben_Repay05-22.docView duplicates
Prevention and Protection Services- Adult Protective Services
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Service Center: Email Address: Phone
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If you are not the intended
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10370.doc