State of Kansas Aftercare Contact Agreement for Young Adults PPS 3070A
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Department for Children and Families (For Cases Where Young Adult is not in the Custody of the Secretary
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Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3070A.docx
(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
Referral for Permanent Custodianship Subsidy Checklist
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This checklist guides the CWCMP through referring a family to receive
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Case Management Provider Contact Agency: Name: Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6149.docx
Provider: Assigned Provider Staff: Phone: Email: Date Aftercare started: Agreement in
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Frequency and method of contacts between case manager and child/family
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_3000_Forms/PPS3070.doc
Prevention and Protection Services PPS CLIENT PURCHASE AGREEMENT
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PPS Worker: Fax: Region: Co: e-mail: @ks.gov Program: Client Information Client
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2833.doc
SOUL Family Legal Permanency shall use this form to send updates to the DCF Regional office at the time changes occur
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Note the following changes and return to the designated office
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6320.doc
Consumer’s work skills, conditions, preferences and interest
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(Recommend other pertinent consumer information be shared with the provider to assist
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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.doc
Section 7 Pre-Employment Transition Services (Pre-ETS
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Protection, use, and release of personal
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or Manager receives a call or email regarding a concern from the Client Assistance Program
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https://www.dcf.ks.gov/services/RS/Documents/Policy/SEC_7-14.docx
Telephone # (Cell) City, State Zip: Email address: Permanent Custodians shall use
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Note the following changes and return to the designated office within thirty (30) days of the
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6170.doc
REPORT/REQUEST FOR SERVICES PPS 1001
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Jul 20 Case Name: Click here to enter text
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Report Date Click here to enter a date
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Email: Employer: Report Source (Relationship) Choose an item
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_1000_Forms/PPS1001.doc