ࡱ> [^Z @ #Abjbj{{ b$ """""""6!!!8iLi6`82!LB"X"X"X"3#3#3# 5777777$9R;79"3#3#3#3#3#7""X"X"8%%%3#("X""X" 5%3# 5%%r1T""2X"|j i![#4k12\080`8y1<#<266""""<"23#3#%3#3#3#3#3#7766  %66 Another Planned Permanent Living Arrangement Agreement(PCW or MCI Wards)Another Planned Permanent Living Arrangement (APPLA) is a plan for a stable, secure living arrangement, developed for a youth that includes relationships with significant adults in their life that will continue beyond foster care. Planned means the arrangement is intended and designed. Permanent means enduring, lasting, or stable. Living arrangement includes not only the physical placement of the child, but also the quality of care, supervision and nurturing that the child will be provided by a specified adult or adults. AGREEMENT The persons involved in this agreement believe that it is in the best interest of the youth to be allowed to remain in the home of the foster parents with all of the supports, privileges and responsibilities that being a member of this family brings. This agreement is being established as a statement of our mutual commitment to a permanent relationship. Although the foster care placement in this home will end when the foster care case closes, it is the relative(s) intent to continue a caring relationship into the youths adulthood. By signing this agreement, the foster parent(s) agree: To maintain the responsibilities of a foster parent(s) for the youth until adulthood. To request support and services from the assigned foster care agency if there are situations that cause concern or conflicts that require assistance. To only terminate this agreement after all possible solutions are tried or under serious or unusual circumstances. To facilitate visitation with the siblings and members of the extended birth family based on the discussion between the caseworker and all parties involved. To share information as required by the agency and as determined appropriate with the birth family. To ensure that the youth is enrolled in and attending school on a full-time basis. To facilitate health and dental care as required. By signing this agreement, the caseworker and assigned foster care agency agree: To maintain and support the long-term placement of the youth in the foster parent(s) home. To respond to requests for services and supports to ensure positive family relationships and stability with the home. To develop the 90-day Transitional Plan for Youth aging out of foster care to ensure that transitioning youth services are in place.To not disrupt this placement except under serious or unusual circumstances and only through an administrative level decision. To ensure that the agreed upon visitation and sharing of information is provided to the siblings. To facilitate between all parties to arrange appropriate scheduling and required transportation for visitation. To respond to requests for facilitation if an issue arises between the parties. By signing this agreement, the youth agrees: To remain in the home of the foster parent (s) with all of the supports, privileges and responsibilities that being a member of this family brings. To ask the foster care worker for support and advice in dealing with issues that arise. SIGNED:Youth Signature(Date) FORMTEXT      Foster Parent(s) Signature(Date) FORMTEXT      Agency Caseworker Signature(Date) FORMTEXT      Foster Care Supervisor Signature(Date)DHS Local Office Director (Date) FORMTEXT      Department of Human Services (DHS) will not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, sex, sexual ori 2<=>DEIPQRSg i s " # $ %  1 ? @ DQ[  VWXYZ[\̸̸̸̸̧̰̟̗ߟhuh7EhuCJaJh7ECJaJhfsCJaJhkF5CJaJh|CJaJh@MCJaJh7Eh7E5CJaJh7Eh7ECJaJhZTCJaJhkFCJaJhfs h7E5h|hkFhfTh7E5<=Pq<kdX$$Ifl4")R&4 la<f4 $Ifgdx4<kd$$Ifl4")R&4 la<f4 $IfgdfT@AB[PQRSh i s t |k]kkkkkd$Ifgd7E$d$Ifa$gd7E<kd$$Ifl4")R&4 la<f4 $Ifgd(,<kd$$Ifl4")R&4 la<f4  '({\W$ & Fd$Ifa$gd7E$d$If^a$gd7E$ & Fd$Ifa$gd7E$d$Ifa$gd7EWXYZ[\t7<kd$$Ifl40")R&4 la<f4<kd$$Ifl4")R&4 la<f4$d$Ifa$gd7E<kd`$$Ifl4")R&4 la<f4\=+,02$d$If^a$gd^ $ & Fd$Ifa$gdRK$d$If^a$gdRK$ & Fd$Ifa$gd7E$ & Fd$Ifa$gdkF \="IWst024BFdfrt|~ zlzjhRKhRKUjhRKUhkFjh/5UmHnHuj$hRKhRKU hRK5jhRK5U hRKhRKhRKhhZTh7Eh7EhRKCJaJh@MCJaJhRKhRK5CJaJh7ECJaJhRKCJaJhkFCJaJ'24DFftp[[$d$$If^a$gd<kd$$Ifl4")R&4 la<f4$d<$If^a$gdZT<kdh$$Ifl4")R&4 la<f4tvxz|~J5$d$If^a$gdx4Okd$$Ifl4 0")~ 4 la<f4$d$If^a$gdRKOkd,$$Ifl4 0")~ 4 la<f4~AOkd$$Ifl4 0")~ 4 la<f4$d$$If^a$gdOkd$$Ifl4 0")~ 4 la<f4 $IfgdRK AOkd$$Ifl4 0")~ 4 la<f4 $IfgdRKOkd$$Ifl4 0")~ 4 la<f4$d$If^a$gdx4VXdfnpr,.:<DFH\^`jlnpv@@@@ A AAAAAƾͰͬ|h/0JmHnHu hA0JjhA0JUhAh(VU huhuhuhx4jb hRKh6KUjh6KU hRKh6Kh6KjhRKhRKUhRK hRKhRKjhRKUjh/UmHnHu0 Xfhjln5Okd$$Ifl4 0")~ 4 la<f4$d$If^a$gdx4Okd$$Ifl4 0")~ 4 la<f4$d$$If^a$gdnp||$d$$If^a$gdOkdt$$Ifl4 0")~ 4 la<f4 $IfgdRK$d$If^a$gdx4JOkdr $$Ifl40")~ 4 la<f4$d$If^a$gdx4Okd$$Ifl4 0")~ 4 la<f4.<>@BJ55$d$If^a$gd6KOkdj $$Ifl4 0")~ 4 la<f4$d$$If^a$gd6KOkd $$Ifl40")~ 4 la<f4BDFnpAOkd $$Ifl4 0")~ 4 la<f4 $Ifgd6K$d$If^a$gd6KOkd $$Ifl4 0")~ 4 la<f4prtvxz|~JOkd $$Ifl40")~ 4 la<f4OkdX $$Ifl4`0")~ 4 la<f4$d$If^a$gdx4~@@@AAAA(LPLxLrmkiimgec>=<gd(V<kd $$Ifl4X")R&4 la<f4$d8$If^a$gdu<kdB $$Ifl4")R&4 la<f4 entation, gender identity or expression, political beliefs or disability. 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DB@xjCoCity D%vGCoCity 0 DB@xjCoState D%vGCoState 2 DB@xjeCoZip D%vGCoZip 4 DB@xjSupervisorName D%vGSupervisorName @ DB@xjSupervisorTitle D%vGSupervisorTitle B DB@xj. Update other Form Fields on Form & Exit Macro- Selected$=GetFormResult$ ("CurrentDate")! TheSerialDate = Today() + 14t$ TheDate$ = Date$(TheSerialDate)& SetFormResult "DueDate", TheDate$) EditGoTo "CreateDate" : UnlinkFields EditGoTo "GranteefirstName"- ToolsProtectDocument .NoReset = 1, .Type = 2/ ToolsProtectSection .Section = 2, .Protect = 0d FileClose 2 SelectName = - 1kpoh`(Attribute VB_Name = "MyInfo" Public Sub Main(X) D.nDescription|Enter Personal rma:zProcDataIInvoke _FuncINoi8l..nADim iRet B  User$ATitleAreaCod-PhonYourExtFax|AC Offic $AddressCitByStat Zip ODILSEB;UN WKRBoss|| 'DEFINE DIALOG BOX WordBasic.BeginDialog 582, 300,} G TextBox 109@ A 5@ 18@ I @ey 56 * 83 _[ 105WDi 2A3321A5r 34 _  | 9 7 @ 1$55E [1 Pi 23` 6i`cV3jFAXAC41e lV1@,CO629 *DI7m pV? 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ClientStateD ClientState Uppercase1Enter the Addressee's 2 digit State Abbreviation. ClientZipD ClientZip UppercaseKEnter the Addressee's Zip Code (+4 if known) (Example: 48909 or 48909-7537)D CoAddress UppercaseaEnter the County's mail address (street address, PO Box, etc., where the mail will be delivered).D CoAreaCodeEnter the County's Area CodeDCoCity UppercaseEnter the County's City.D CoExtensiond8(OJQJ_HmH sH tH XOX CaseNumber1?d8(OJQJ_HmH sH tH XOX ClientCity1@d8(OJQJ_HmH sH tH ZOZ ClientState1Ad8(OJQJ_HmH sH tH ZO"Z ClientZip1BdtCJOJQJ_HmH sH tH VO2V CoAddress1Cd8(OJQJ_HmH sH tH XOBX CoAreaCode1 Dd`CJOJQJ_HmH sH tH PORP CoCity1Ed8(OJQJ_HmH sH tH ZObZ CoExtension1Fd8(OJQJ_HmH sH tH ^Or^ CoPhoneNumber1Gd8(OJQJ_HmH sH tH ROR CoState1Hd8(OJQJ_HmH sH tH ^O^ CoSuppaddress1Id8(OJQJ_HmH sH tH XOX CountyName1Jd8(OJQJ_HmH sH tH \O\ CountyNumber1 Kd`CJOJQJ_HmH sH tH ROR CoZip1LdtCJOJQJ_HmH sH tH NON Date11 Md`CJOJQJ_HmH sH tH TOT District2 Nd`CJOJQJ_HmH sH tH LOL FaxAC Od`CJOJQJ_HmH sH tH VOV FirstName1Pd8(OJQJ_HmH sH tH XOX FirstName21Qd8(OJQJ_HmH sH tH `O"` GranteeAddress1 Rd`CJOJQJ_HmH sH tH \O2\ GranteeCareof Sd`CJOJQJ_HmH sH tH XOBX GranteeCity Td`CJOJQJ_HmH sH tH `OR` GranteeClientID Ud`CJOJQJ_HmH sH tH dObd GranteeFirstName2 Vd`CJOJQJ_HmH sH tH bOrb GranteeLastName1Wd8(OJQJ_HmH sH tH ZOZ GranteeState Xd`CJOJQJ_HmH sH tH VOV GranteeZip Yd`CJOJQJ_HmH sH tH TOT LastName1Zd8(OJQJ_HmH sH tH VOV LastName21[d8(OJQJ_HmH sH tH ROR OtherID1\d8(OJQJ_HmH sH tH ROR Section2 ]d`CJOJQJ_HmH sH tH ^O^ SuperAreaCode1 ^d`CJOJQJ_HmH sH tH `O` SuperExtension1_d8(OJQJ_HmH sH tH dOd SuperPhoneNumber1`d8(OJQJ_HmH sH tH `O` SupervisorName1ad8(OJQJ_HmH sH tH LO"L Unit2 bd`CJOJQJ_HmH sH tH PO2P Worker2 cd`CJOJQJ_HmH sH tH `OB` WorkerAreaCode1 dd`CJOJQJ_HmH sH tH bORb WorkerExtension1ed8(OJQJ_HmH sH tH TObT WorkerFax fd`CJOJQJ_HmH sH tH XOrX WorkerName1gd8(OJQJ_HmH sH tH \O\ WorkerName2hd8(5OJQJ_HmH sH tH ZOZ WorkerPhone1id8(OJQJ_HmH sH tH ^O^ WorkerTitle1jd8(5OJQJ_HmH sH tH LOL Emailkd8(OJQJ_HmH sH tH b}@0h0Address1BureauCareOf CaseNumber ClientCity ClientState ClientZip CoAddress CoAreaCodeCoCity CoExtension CoPhoneNumber CoState CoSuppaddress CountyName CountyNumberCoZipDate1DistrictEmail/FaxAC FirstName FirstName2GranteeAddress1 GranteeCareof GranteeCityGranteeClientIDGranteeFirstNameGranteeLastName GranteeState GranteeZipLastName LastName2OtherID Section! 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\APMjNOYLZB[ !)*+/0P W\2t~ nBp~xLXB[ (.B[  &(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@L L |L L (`L`N`XUnknownGz Times New Roman5Symbol3& z Arial?5 z Courier New;Wingdings"h0@?Yq