Subsidized Independent Living (SIL) Formal Review/Agreement

The requirements for the Independent Living Subsidized Program are described below. Before a youth can be staffed into the subsidized program, all of the following requirements must be met. This review is required for all foster youth 16 and 17 years of age.

Subsidized Independent Living Agreement: A written agreement must be developed between the youth, CDS Family & Behavioral Health Services (CDS) and the Partnership for Strong Families (PSF) prior to the youth beginning SIL. The agreement must be reviewed and updated annually, but more frequently as needed. The agreement must include, at a minimum: a. A description of the youth’s educational program, school or college, including start date, ending date and educational goals. b. The youth’s responsibilities, including and not limited to regular attendance and/or completion of life skills training, submission of payment stubs from work monthly or report from an official conducting the youth’s extracurricular activities that verifies continued involvement, and verification of school attendance. c. CDS and PSF responsibilities, including and not limited to regular staffings, frequent Family Care Counselor (FCC) contacts, provision of life skills training, counseling, and therapy. d. Requirements for continued eligibility in the SIL arrangement. e. A target date for discharge and the completion of the goals and objectives in the case plan. f. An acknowledgement that this placement is in the youth’s best interest and that safety concerns have been addressed. In addition, to prevent the independent living program from losing community support, gaining a poor public image and possibly losing statutory authority, the youth must be informed in writing by the Independent Living Coordinator of the consequences of behavior that violates the law or community standards. Program participants have a responsibility beyond themselves, extending to the department and to fellow program participants. g. A full explanation of the consequences of the youth’s non-compliance with the Subsidized Independent Living requirements.

Name: ______DOB: ______Age: ______

Counselor: ______County: ______

Target date for completion of the goals and objectives in the case plan:______

Target date for discharge:______

SIL Initial and Continuing Eligibility Requirements:

Place an (X) by all of the requirements that have been met.

_____ Is 16 or 17 years old

_____ Enrolled in school full-time, attends regularly, maintains at least 12 credit hours.

Rev. 5/10, 10/11 1 F-PR-1277 Identify the youths Educational Goals: ______

______

Educational Goal Start Date______Anticipated Completion Date______

Has a cumulative GPA of 3.0 or higher – verification attached yes no.

Has established a savings account, savings balance $______. (Must meet moving expenses.)

Provided a personal statement of intent, why they should be accepted and how they will benefit.

Currently employed, earns at least $100 monthly – verification attached _ yes __ no OR Is involved in extracurricular activities monthly – verification attached yes no

Has prepared a monthly budget including all income and expenses.

Has not been on runaway status for the past 6 months.

Does not have any current law violations, pending charges or any open case with law enforcement.

Regularly participates in Independent Living life skills training.

Exhibits appropriate behavior in home, school, workplace and community.

Has received a recommendation from the IL and PSF counselors and supervisors.

Meets eligibility criteria: Yes No

If not, needs to do the following:

Rev. 5/10, 10/11 2 F-PR-1277 Review and Sign Section I or Section II is applicable below:

Section I Participating in SIL is a big responsibility. I understand and agree that I must continue to meet all eligibility criteria, abide by the law and represent myself and the SIL program in a manner that is consistent with a positive image in the community. I further understand and agree that to not do so, jeopardizes my continued participation in the program and could negatively impact opportunities for future participants and the program. I am committed to being successful and have reviewed and discussed the information in this form with my Independent Living Counselor and Family Care Counselor.

______Youths Name Youths Signature Date

By signing below, we acknowledge that it is our belief that the youth’s best interests will be served by their participation in SIL and any safety concerns have been considered and thoroughly discussed. We further acknowledge that the Family Care Counselor will maintain the primary responsibility for ensuring the youths therapeutic needs are addressed and the Independent Living Counselor will continue to provide educational assistance with Life Skills development.

Signature: ______PSF Family Care Counselor Youth

______Independent Living Counselor Approval Authority CDS Family & Behavioral Health Services

Section 2 By signing below, we acknowledge that we have reviewed the eligibility criteria for SIL and either the youth does not currently meet all of the necessary placement criteria or the SIL program is not currently in the best interest of the youth. We further acknowledge that the Family Care Counselor will maintain the primary responsibility for ensuring the youths therapeutic needs are addressed and the Independent Living Counselor will continue to provide educational assistance with Life Skills development.

______Youths Name Youths Signature Date

Rev. 5/10, 10/11 3 F-PR-1277 ______FCC Name FCC Name Signature Date

______IL Counselor Name IL Counselor Signature Date

Rev. 5/10, 10/11 4 F-PR-1277