<p> 1169 PERMANENCY PLAN Pursuant to K.S.A. 38-2263</p><p>☐ Initial Plan for Court, submitted to the Court on _____ day of ______, ______</p><p>Child Name ______Year of Birth ______Court Case # ______</p><p>Other Household Members______Person preparing form: Name, Address, Telephone Number, [Fax Number], and [E-mail Address] ______</p><p>Permanency Planning Conference Date: ______Attending: ______</p><p>☐ Child is under the age of 14 years old. or ☐ Child is 14 years of age or older and has been consulted regarding this plan.</p><p>Permanency Plan is effective from: ______to: ______</p><p>Previous Permanency Planning Conference from: ______to: ______</p><p>Permanency Goal: (check one of the following) ☐ Maintain at Home ☐ Reintegration ☐ Adoption ☐ Permanent Custodianship ☐ Another planned permanency living arrangement ______</p><p>If the permanency goal has changed from the previous case plan, state reason for change: ______</p><p>The state of the child’s physical, mental and emotional health, and educational functioning is: ______</p><p>Family’s/Child’s strengths and resources ______</p><p>Family’s/Child’s needs ______</p><p>Rev. 07/2016 ©KSJC 1 The services to be provided to the child, the parents and the placement are: ______</p><p>The tasks and responsibilities designed to achieve the plan, and to whom they are assigned, are: ______</p><p>The objectives and time schedule for achieving the permanency plan are: (Include the plan for reintegration if reintegration is a viable alternative) ______</p><p>The following placement alternatives are available: (For use if the child is placed out of the home)______</p><p>The placement selected is appropriate because: (For use if the child is not placed in the parent’s or custodian’s home. Include a description of the safety of the placement.) ______</p><p>Summarize progress made in achieving case plan goal since the last case planning conference. ______</p><p>Concurrent Case Plan: ☐ Adoption ☐ Guardianship ☐ A.P.P.L.A. ______☐ N/A Reason: ______</p><p>Rev. 07/2016 ©KSJC 2 Authority</p><p>K.S.A. 38-2263.</p><p>Notes on Use</p><p>A permanency plan shall be developed and submitted to the court within 30 days of the court’s initial custody order. This form may be used by a court services officer or custodian if the child is not in the secretary’s custody and the secretary is not providing services to the child. This form is to be prepared in consultation with the child, if 14 years of age or older, and the parents, when possible. The purpose of the permanency plan is to assure, in so far as is possible, that children have permanency and stability in their living situations, and that the continuity of family relationships is preserved. The safety and well-being of the children is paramount.</p><p>Comments</p><p>Appeals from a reintegration plan are from the court’s approval of the plan, rather than subject to the agency’s administrative review procedures. In re J.G., 12 Kan. App. 2d 44, 734 P.2d 1195 (1987).</p><p>Rev. 07/2016 ©KSJC 3</p>