A. Social Security Benefits: Yes No If yes, amount
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Anticipated date of youth’s high school graduation
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PPS Administration Use Only for Approval
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6301.doc
Income of the child (include all income and the source
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Note: Reference Sections 6112C and 6113 in the PPS PPM
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Please attach statement from family as to why they wish to pursue
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6150.doc
How DCF will support My Plan: Completed by
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I have been part of the decision making and understand that the above agreement requires my participation
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Client Email
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Career Navigator Email
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https://content.dcf.ks.gov/EES/KEESM/Appendix/E-9_GOALS-Self-SufficiencyAgreement04-20.docxView duplicates
I. Applicant Information I/We are applying to become an adoptive resource for a
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Applicant 1: Email: Phone: Applicant 2: Email: Phone: Street Address: City, State and Zip
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5316.doc
I hereby give my permission to the Kansas Department for Children and Families to release
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your identifying information (name, address, email address and/or telephone numbers), do not
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_0000_Forms/PPS0350.doc
Department for Children and Families REV 07/2021
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Phone Number and Email for APS Specialist
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We received the attached APS report that a criminal act has occurred or
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Officer Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_10000_Forms/PPS10120_A.docx
How DCF will support My Plan: Completed by
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I have been part of the decision making and understand that the above agreement requires my participation
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Client Email
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Career Navigator Email
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https://content.dcf.ks.gov/EES/KEESM/Appendix/E-8 TANF Self-Sufficiency Agreement 03-2019_.docxView duplicates
form is to be sent via encrypted email to DCF.SBDT@ks.gov with the client’s home region as
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https://content.dcf.ks.gov/ees/KEESM/Forms/ES-4412_Client_Turn_Around_Form.docView duplicates
For questions that do not apply
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Home Phone Work / Office # Cellular / Other # Email Address
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with my advisor and promptly report any changes in my address, phone number or email address
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Appendices/Appendix_7B.doc
Email
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Regulatory Compliance and Quality Assurance Administrator, Racheal Sain
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Supervises Regional Supervisors and Training Specialist
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https://www.dcf.ks.gov/services/PPS/FCL/Documents/FCL_forms/Licensing Staff Contact List.docx