ࡱ> ^`]%` 1bjbjٕ 4F0PPPd8$d4d;h(   Q""lg#8:::::::$=h?|:uP$!^Q"$$:  n;'''$8 P :'$:''78PS9  9{%/8:;0;C8@&@(S9@PS9#>#,' $$-$###::9'^###;$$$$ddd  dddddd State of Illinois Department of Children and Family Services Placement Alternative Contract 90 Day Self-Sufficiency Plan I,  FORMTEXT       , date of birth  FORMTEXT       , (at least 18 years of age) have identified  FORMTEXT       , whose phone number is  FORMTEXT       , who is willing to serve as my advocate. My caseworker is  FORMTEXT       , whose phone number is  FORMTEXT       . I have identified a place where I can live. The address is:  FORMTEXT        FORMTEXT       . My caseworker has been to see my proposed living arrangement and has determined that it is  safe using the minimum safety requirements set out in the CFS 453-A, Placement Alternative Contract, and if a child will be visiting or living with me, the CFS 453-B, Additional Safety Checklist for a Parenting Youth, and he/she believes that I am capable to plan toward my emancipation. I understand and agree that I must complete or make reasonable progress toward completion of the tasks listed below over the next 90 days in order to extend a Placement Alternative Contract or make a successful transition to emancipation from DCFS wardship. If I do not make reasonable progress, I will be offered a more structured placement and required to participate in any clinically recommended services, or offered the option to continue to live on my own with services but without the Standard of Need payment for a maximum 90-day period. My advocate and I have established the following tasks for this 90-day period. Completing these tasks will make me more prepared for emancipation. (INSERT LIST OF OBJECTIVES AND TASKS HERE should be written to reflect a 90 day term)  FORMTEXT       I acknowledge that these are my objectives and tasks as I prioritized them, and that it is my responsibility to prepare myself for emancipation. I understand that the Illinois Department of Children and Family Services has contracted with  FORMTEXT       (agency name) to help me to complete my tasks, support my efforts, and provide me with some financial assistance in order to assist me in achieving my goal of emancipation. I understand that in order to remain eligible for the Placement Alternative Contract, I must make reasonable progress toward the goal of emancipation by addressing the tasks identified above on a daily and/or weekly basis. If I am unable to demonstrate reasonable progress toward emancipation within 90 days, I will be referred to a more structured setting such as a group home or transitional living program. I understand that if I fail to make reasonable progress toward completion of these tasks and choose not to live in a structured placement selected for me, I will be ineligible for monetary support from the Department and my placement will be considered as an unapproved placement. I understand that in order to continue to be eligible for a Placement Alternative Contract I must reside within the State of Illinois. I understand that if my actions or inactions indicate that I am unwilling to be subject to the Departments authority and I have not been adjudicated by the court to be incompetent to function as an adult, my case may be recommended for closure. $&|     $ & ( * , ĹtjXtDt:h(hZ@>*CJ'jh(h(>*CJUmHnHu"jh(h\Bv>*CJUh(h(>*CJjh(h(>*CJUh(hQCJh(hWCJh(h(5CJ\h(hW5CJ\h(hW5\aJh(hW5>*\h(hW>*h(hW5>*CJaJh(hZ@5>*CJaJ.jh(hZ@5>*CJUaJmHnHu&|~ N P Hdhgd($ dha$gd($ B$dha$gd($ B$0dh^`0a$gd( $dha$gd($ 6!da$gd($a$$a$D1t11, . H J ^ ` b l n p t v  & ( < > @ J L N R p ߯ߥՁ߯we߯^ h4R>*CJ"j\h(h\Bv>*CJUh(hW>*CJ"jh(h\Bv>*CJUh(hWCJh(h|mCJh(hZ@>*CJ'jh(h(>*CJUmHnHu"jth(h\Bv>*CJUh(h(>*CJjh(h(>*CJUh(h[FCJh(hVCJ$ " $ 8 : < F H J L N P ʸԤԚvԤԚmbmPԤ"jh(h\Bv>*CJUh(hWCJaJh(hWCJ"jDh(h\Bv>*CJUh(hZ@CJh(hkCJh(hZ@>*CJ'jh(h(>*CJUmHnHu"jh(h\Bv>*CJUh(h(>*CJjh(h(>*CJUh(h(CJh(hQCJaJh(hQCJ     " ( < B X ^ ` b f '-H쒉zqzf]h(hQCJh(hWCJaJh(h^CJ h$CJh(h hCJh(hECJh(hiCJh(h7eCJh(h8CJh(hZ@CJ!jh4R>*CJUmHnHu"j,h4Rh(m>*CJU h4R>*CJjh4R>*CJUh(hWCJh(hZ@>*CJ$/09:EF HIr  ng` hQ>*CJ h(>*CJ'jh(h(>*CJUmHnHu"jh(h\Bv>*CJUh(h(>*CJjh(h(>*CJUh(h abCJh4Rh(CJh(hWCJaJh(h.pCJh(h^CJh(h&[CJh(h@1?CJh(hQCJh(hWCJ#HI|~"-L-N-P-R-$a$$ $dPa$gdZ@ $dPa$gdZ@dPgdZ@ $dPa$gdZ@$ $dPa$gdZ@ $ $a$gd4R$ $dPa$gd( $dPa$gd( $dha$gd(  ,,,"-$-8-:-<-̺֦֜{i[Fi)jh4Rh(m5>*CJUaJh4Rh4R5>*CJaJ#jh4Rh4R5>*CJUaJh(hECJaJh(hWCJaJUh(h|#CJh(hZ@>*CJ'jh4Rh4R>*CJUmHnHu"jh4Rh(m>*CJUh4Rh4R>*CJjh4Rh4R>*CJUh(hW5CJ\h(hWCJ h4RCJI have the following concerns or needs that I want to address or to have help with as part of this contract (attach additional pages as needed):  FORMTEXT       Date Case ID Youth s Signature Date Advocate s Signature Date Caseworkers Signature Youth are encouraged to consult with their Attorney/Guardian ad litem in making this decision. However, whether or not the Attorney/Guardian ad litem is included, a Placement Alternative Contract is the sole choice of the youth and failure to consult with an Attorney/Guardian ad litem in no way impacts the enforcement of this agreement. 90 Day Extension of Placement Alternative Contract: Date: Granted  FORMCHECKBOX  Denied  FORMCHECKBOX  Date Caseworkers Signature  90 Day Extension of Placement Alternative Contract: Date: Granted  FORMCHECKBOX  Denied  FORMCHECKBOX  Date Caseworkers Signature  90 Day Extension of Placement Alternative Contract: Date: Granted  FORMCHECKBOX  Denied  FORMCHECKBOX  Date Caseworkers Signature     Page  PAGE 1 of  NUMPAGES 3 CFS 453-C 7/2008 <-F-H-L-N-R-T-V-`-b-t-v-x------------------.....=.F...Ⱥznzbzbh(h|#>*CJaJh(h h>*CJaJh(hW>*CJaJ hWCJh(h,CJ h4uCJh(h4uCJ h,CJ h,>*CJh(hWCJh(hZ@5>*CJaJh4RhZ@5>*CJaJ#jh4Rh4R5>*CJUaJ.jh4Rh4R5>*CJUaJmHnHu&R-x---------...f/h////////0000 $  a$gd,$a$$a$gd4u <$gd,......1/f/g/h/x///////////////////ƾqbMbqqb)jh,h\Bv5>*CJUaJjh,5>*CJUaJh(hrh5>*CJaJh,5CJaJh,5>*CJaJh(h4u5>*CJaJh(h,>*CJaJh4u>*CJaJh,h4u>*h,h1>*h(h4u>*CJaJh4R>*CJaJh(h>b>*CJaJh(hZ>*CJaJh(hW>*CJaJ///////////0000000 00=0>0?0D0E0~vneYK@h,5>*CJaJh(h,5>*CJaJh(h,>*CJaJhE>*CJaJh,hE>*h,h1>*h,hM5>*CJaJjh,CJUmHnHu h4uCJh(h,CJ h,CJ h,>*CJh(h4uCJh(h4u>*CJaJh(h4u5>*CJaJjh,5>*CJUaJ)jth,h\Bv5>*CJUaJ0000 0=0>0?000000000000000gdE <$gd,gd,$a$gd, $  a$gd,$a$gdE$a$$a$gdMgd4uE0F0R0S0a0b0c0n0o0}0~0000000000000000000ιΤ蘏|lc[SJhE>*CJaJh,hE>*h,h1>*h,>*CJaJjh,CJUmHnHu hECJ h,CJ h,>*CJh(h,CJh(h,>*CJaJ)j\h,h,5>*CJUaJ)jh,h,5>*CJUaJh,5>*CJaJjh,5>*CJUaJh(h,5>*CJaJh,5CJaJ00!1"1#1,1C1D1F1G1I1J1L1M1O1P1r1s1t1~1111gdZ@$a$gd 9 <$gd,gd,$a$gd, $  a$gd,$a$gdE0000001111111 1!1"1#1$1%1*1+1B1C1D1E1G1H1J1K1M1N1P1U1V1\1]1򙐉|tptptptpldldjh 9Uh 9h\Mjh\MU h(hE h,CJ h,>*CJh(h,CJh(h,>*CJaJ)jDh,h,5>*CJUaJ)jh,h,5>*CJUaJjh,5>*CJUaJh,5CJaJh,5>*CJaJh(h,5>*CJaJ#]1^1_1c1d1n1o1p1q1r1s1t1|1}1~111111 h(hEhZ@hgCJaJh@CJaJhXbhZ@CJaJh\Mh\Bvh 9jh 9UhbmHnHu11$a$gd,21h:p(/ =!"#$% tDText2tDText4tDText3tDText5tDText6tDText7tDText8tDText9tDText1vDText10vDText11tDeCheck1tDeCheck2tDeCheck1tDeCheck2tDeCheck1tDeCheck2@@@ NormalCJ_HaJmH sH tH RR Heading 1$8@&^85OJQJ\^JaJNN Heading 2$@&5CJOJQJ\^JaJJJ Heading 3$@&5OJQJ\^JaJRR Heading 4$@&^5OJQJ\^JaJDAD Default Paragraph FontViV  Table Normal :V 44 la (k(No List :>@: Title$a$ 5>*\aJ8B@8 Body Text 5\aJ44 Header  !4 @"4 Footer  !8P@28 Body Text 2$a$''F>?^{|}STHIlm 0 E F G H [ m n o x ;<=~ !*ABCDFGHI}~$%(0000000000000000000000000000000000000000000000000@0@0@0@0000000000000000000000000000@0@0@0@00@0H00@0H00@0H00@0H00@00 0 xF:H00< 000\M>?^{|}STHIlm 0 E F G H [ m n o x ;<=~ !*ABCDFGHI}~$(000000000000000000000A0@0/00000000000000000000000000@0@0@0@0000000000000000000000000000@0@0@000000\M ///2, <-./E00]11  !HR-0011"1%eqw 0 < B P`l| 'FFFFFFFFFFFG G G$G$G$G$*,2!8  @ F(  V  # "` TB   c $D TB   c $D B S  ?D'{0.t &t &t Text2Text4Text3Text5Text6Text7Text8Text9Text1Text10Text11Check1Check2f1 Qm( &x C a}(!g"<#b abd7epl(m|m]o.pqA#q,q\Bva{rh|#4u,Z@LKeOZ\Moiw h(^`WiFXgH{WMi8\[=\ V D< bcQIk!8[F@D2p '`` ` `@```,@`,`\@UnknownGz Times New Roman5Symbol3& z Arial5& zaTahoma?5 z Courier New;Wingdings"1h^f^fJ&^^.E!N4d2QHX ?^*Placement Alternative ContractDCFSsmy5187(       Oh+'0  ( H T ` lx Placement Alternative ContractDCFSNormalsmy51872Microsoft Office Word@F#@dA@[@[^7display_urn:schemas-microsoft-com:office:office#Author xd_SignatureOrder TemplateUrl xd_ProgID PublishingStartDate PublishingExpirans:ds="http://schemas.openxmlformats.org/officeDocument/2006/customXml"/>w>ffice/2006/metadata/longProperties"/> ?@ABCDEFGHIJKLNOPQRSTpXYZ[\d_bvcVefghijklmnoqwURoot Entry F0Zta Data $1Table,(@WordDocument4FSummaryInformation(MDocumentSummaryInformation8CompObjqMsoDataStore0Zt0Zt # !"$%&'()*+  FMicrosoft Office Word Document MSWordDocWord.Document.89q repoint/v3/contenttype/forms">DocumentLibraryFMOT4CGKJT==2 0Zt0ZtItem  PropertiesVGSENBQ==2 0Zt0ZtItem  Properties ZI1TRAUZOFQPP==2 0Zt0ZtItem W "="MigrationSourceURL" ma:index="10" nillable="true" ma:displayName="MigrationSourceURL" ma:internalName="MigrationSourceURL0"> This value indicates the number of saves or revisions. 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