Closed Case - Youth in Transition (YIT) Funding Eligibility Checklist
Michigan Department of Health and Human Services
This form is used to determine YIT eligibility for cases that cannot be accessed in MiSACWIS. It does not replace FOM 950 policy. This form is not used for approval of specific YIT funding requests. It corresponds to the eligibility requirements in FOM 950 and must be completed, signed and added to the case record prior to authorization of any YIT funding.
Name (Last, First, M.I.)	Date of Birth	Sex
Male	Female
Address	City	State	Zip Code
Telephone Number	Case Number
CLOSED CASE YOUTH
Was the youth in foster care placement under the care and supervision of MDHHS, another state’s child welfare agency, or a Tribe, after the 14th birthday?	Yes	No	N/A
Youth is currently between the ages of 18-22 Or	Yes	No	N/A
Youth is currently between the ages of 16-17 and YIT services for the youth were accessed prior to case closing.	Yes	No	N/A
DOCUMENTATION The following documentation and information is in the youth’s case record.
Birth Certificate	Yes	No
Initial court order showing date entered care	Yes	No
Closed case court order showing closed date (if applicable)	Yes	No
FINAL DETERMINATION
This youth has been determined YIT Eligible as a Closed Case Youth.	Yes	No
SIGNATURES (Verifies the final determination, review and completion of this form.)
Foster Care Worker Signature	Date
Foster Care Worker (printed)	Date
Foster Care Supervisor Signature	Date
Foster Care Supervisor (printed)	Date
The Michigan Department of Health and Human Services (MDHHS) does not discriminate against any individual or group because of race, religion, age, national origin, color, height, weight, marital status, genetic information, sex, sexual orientation, gender identity or expression, political beliefs or disability.