ࡱ> '` G_bjbj{P{P *:: O .  ,,,8tl&ut @,-\^/t/t/t/O0R040> @ @ @ @ @ @$ BhrD/@i 0O0O000/@ t/t/@A6A6A60X t/ t/>A60>A6A6 A6t/v n(,I1XA66$@0@A6E1\EA6E O600A600000/@/@3D000@0000 D' '  PLACEMENT WITH A FIT AND WILLING RELATIVEPermanency Goal ApprovalMichigan Department of Human ServicesPlease print or type.Case NameAgeDate of Birth FORMTEXT       FORMTEXT       FORMTEXT      SWSS Log NumberCourt File Number FORMTEXT       FORMTEXT      Relative NameRelationshipDate of Placement FORMTEXT       FORMTEXT       FORMTEXT      FC WorkerAgency FORMTEXT       FORMTEXT      FC Worker s email addressFC Worker Telephone NumberFC Worker Fax Number FORMTEXT       FORMTEXT       FORMTEXT      Indicate relative s licensure status FORMCHECKBOX  Licensed FH or FORMCHECKBOX  WaiverThe permanency goal of placement with a fit and willing relative is appropriate for the above named youth as documented by the following:a.Reunification, adoption and guardianship have been ruled out as the permanency plan for the child. Efforts have been made to achieve permanency through the three preferred permanency goals for the child and documented in the case service plans. Below are the compelling reasons why the respective alternative permanency planning goal is not in the childs best interests.Permanency GoalCompelling ReasonReunification FORMTEXT      Adoption FORMTEXT      Guardianship FORMTEXT      b.The selected relative has cleared all required background checks for placement. Date of criminal history clearance FORMTEXT      Date of Central Registry clearance FORMTEXT      Date of home study FORMTEXT      c.The relative has committed to long-term care and responsibility for the child and has legitimate reasons for not pursuing adoption or guardianship. The reasons are:  FORMTEXT      d.Summary of the child s best interests to remain in the home of this relative rather than be considered for adoption by another relative or other person. 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ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. 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SuperAreaCode"SuperExtension#SuperPhoneNumber$SupervisorName%Unit&Worker'WorkerAreaCode(WorkerExtension) WorkerFax* WorkerName+ WorkerName2, WorkerPhone- WorkerTitle.0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictFaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstName1GranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitleUser Input 10pt(<Pdu$5I]n  4EYm(<Pdx z |UpX_^RȠ B &4<ELNORT X R : | TBn`6TT6UU V`VV*WxWWWxXXzYYY[[B_B  !"#$%'()012356789:;=>?@ABCDMSB  &(4:<HNP\bdpsu"$035AGIU[]ilnz   ,24@CEQWYekmy"&(4:<HNP\bdpvxFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFFF0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumberCoState CoSuppaddress CountyName CountyNumberCoZipdate1DistrictEmailFaxAC FirstName FirstName2GranteeAddress1 GranteeCareOf GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherIDSection SuperAreaCodeSuperExtensionSuperPhoneNumberSupervisorNameUnitWorkerWorkerAreaCodeWorkerExtension WorkerFax WorkerName WorkerName2 WorkerPhone WorkerTitle)=Qev%6J^o !5FZn)=Qey  !"#$%&'()*+,-./';Oct#4H\m 3DXl';OcwYq@ ٝ  (UnknownG: Times New Roman5Symbol3& : Arial?5 z Courier New5& zaTahoma"h0@P?Yq2