☐ 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
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
Your Current Name: Your Telephone: Your Street Address: Your City/State/Zip: Birth
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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/PPS0335.doc
Attention Referral Agency: The Kansas Department for Children and Families (DCF) is providing this referral in accordance with K.S.A. 38 2290
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Per K.S.A. 38-2290, upon DCF's receipt
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EMAIL
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_2000_Forms/PPS2014_B.docx
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
All items are attached to an email and sent to corresponding regional email, including “County.SOUL FAMILY SUBSIDY.Youth
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Follow instructions prompted within email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6300.docx
DCF REGION: SERVICE COUNTY: PROVIDER: REQUESTOR Name (f, mi., l): SSN: Address
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PPS STAFF NAME: DATE: PHONE: EMAIL: PPS SUPERVISOR AUTHORIZATION: Supervisor or
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_4000_Forms/PPS4007.doc
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
Mailing Address (Street, City, State, Zip Code
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Email
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I/We agree to make monthly payments of $ __per month for consecutive months to complete repayment of the debt
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_6000_Forms/PPS6180.doc
Prevention and Protection Services PPS 10350
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REV 07/2021 Notification to Law Enforcement
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Please type or print Involved Adult: Name Date Received by
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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.doc