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
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
Section I: Student Eligibility (To Be Completed By Youth
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Email Address
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Registrar’s Office: Please email this form to the Kansas DCF Administration Office at
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(EMAIL ONLY
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_7000_Forms/PPS7260.docx
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
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
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
(Check One) Initial Referral Profile Update Today’s Date
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Race/Ethnicity: (check all that apply
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Native Hawaiian or Other Pacific Islander
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Worker Email
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_5000_Forms/PPS5320.docx
Address: Reason: Family new phone/email New Phone/email: Child-only new phone/email New Phone/email: Other Contact Information Change Child's Eligibility
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https://www.dcf.ks.gov/services/PPS/Documents/PPM_Forms/Section_9000_Forms/PPS9121.doc
Your Current Name: Your Telephone: Your Street Address: Your City/State/Zip: Your
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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/PPS0330.doc