HomeMy WebLinkAboutC03-096 Chafee Foster Care Independence Care Program• •
REQUEST FOR STATE APPROVAL OF PLAN
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If this box is checked please complete all portions of the plan related to Chafee Foster Care
Independence Program (CFCIP), otherwise all statements throughout this document will be considered not
applicable.
This Core Services Plan is hereby submitted for EAGLE
[Indicate county name(s) and lead county if this is a multi-county plan], for the period June 1, 2003, through
May 31, 2004. The Plan includes the following:
~ Completed "Statement of Assurances";
~ Completed Statement of the eight (8) required Core services to be provided or
purchased and a list of county optional services, County Designed Program
Services, to be provided or purchased;
~ Completed program description of each proposed "County Designed Service' ;
~ Completed "Information on Fees" form;
~ Completed "Direct Service Delivery" form;
~ Completed "Purchase of Service Delivery" form;
~ Completed "Projected Outcomes" form;
~ Completed "Overhead Cost" form;
~ Completed "Final Budget Page" form;
~ Completed "State Boazd Summary"; and,
~ Completed "100% Funding Summary" form.
This CFCIP plan is hereby submitted for [Indicate
county name(s) and lead county if this is a multi-county plan], for the perm July 1, 2003, through June 30,
2004. The Plan includes the following:
~ Completed "Request for State Approval" form
~ Completed "State of Assurances" form
~ Completed "Chafee Foster Care Independence Program" format
~ Completed "Direct Service Delivery" and/or "Purchased Service Delivery"
form
~ Completed "Youth Direct" form
~ Completed "Final Budget page"
This Core Services and Chafee Foster Caze Independence Program Plan has been developed in accordance with
State Department of Human Services rules and is hereby submitted to the Colorado Department of Human
Services, Division of Child Welfare Services for approval. If the enclosed proposed Core Services and/or
Chafee Foster Care Independence Program Plan is approved, the plan will be administered in confornuty with
its provisions and the provisions of State Department rules.
The person who will act as primary contact person for the Core Services Plan is, Catherine Crane and can be
reached at telephone number 970-328-8856 The primary contact person for CFCIP is
and can be reached at telephone number
If two or more counties propose this plan, the required signatures below aze to be completed by each county, as
appropriate Please~ttach an additional signature page as needed.
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Signature, D OR, C DEPARTMENT OF SOCIAL SERVICES G/ DATE
~ ~ afore, LACE ALTERNATIVES COMMISSION DATE
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~ot®n~~® gnature, C BO OF CO HERS DATE
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