Form DCF-066 "Juvenile Services - Expectations of Placement" - Connecticut

What Is Form DCF-066?

This is a legal form that was released by the Connecticut State Department of Children and Families - a government authority operating within Connecticut. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on November 1, 2008;
  • The latest edition provided by the Connecticut State Department of Children and Families;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form DCF-066 by clicking the link below or browse more documents and templates provided by the Connecticut State Department of Children and Families.

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Download Form DCF-066 "Juvenile Services - Expectations of Placement" - Connecticut

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Department of Children and Families
JUVENILE SERVICES – EXPECTATIONS OF PLACEMENT
DCF-066
11/08 (Rev.)
Client Name:
Date of Placement:
DOB:
DOC:
Commitment End Date:
Parole Services Officer:
Phone
The Commissioner of Children and Families or his/her designee, having reviewed and considered your case, has decided to place you at:
Name of Placement:
No and Street Address:
City/Town:
State:
Zip:
Although you are not yet on parole while at this placement, you have been assigned a Parole Services Officer who will help you adjust to your
new placement and help prepare you for eventual transition to parole status. Whenever problems arise, or you do not understand what is
expected of you while in placement, you may consult with your Parole Services Officer, who will assist you.
If at any time you believe your placement is not meeting your treatment needs, you may request a Treatment Plan Hearing, by writing to the
Commissioner of DCF, specifically stating the elements of your treatment plan with which you are not in agreement. You are encouraged to
request a Treatment Plan Hearing rather than leaving a placement without permission and accruing additional charges by doing so.
EXPECTATIONS:
1.
You must obey the rules and requirements of the above-named placement and comply with treatment recommendations.
2.
You must return to the above-named placement as scheduled and at the appointed time, from any passes or furloughs,
and you must not leave the above-named placement without first obtaining permission from:
3.
You must at no time own, possess, use, sell, or have under your control any weapon or firearm.
4.
You must not use, possess or control, any illegal drug, narcotic or intoxicating substance. (marijuana, cocaine, heroin, Ecstasy, LSD, etc.).
5.
You must not use, possess, or control any form of alcoholic beverages.
6.
You must not use, possess or control any legal prescription medication unless prescribed for you by a licensed physician
7.
You must attend school and all scheduled classes. If you are suspended from school you must immediately notify your Parole Services
Officer. If you are officially withdrawn from school with parental/guardian permission, or have completed school, you must cooperate with
alternative programming or maintain employment.
8.
You must not violate any law, statute, regulation, or ordinance of the United States, State of Connecticut, any other state, county, city, town
or municipality. If you are arrested, you must notify your Parole Services Officer immediately!
9.
You must maintain contact with your Parole Services Officer and comply with the following Special requirements:
A. You must comply with random drug screening by Parole Services or its designee
B.
C.
D.
I have read, or have had read to me, the expectations and I fully understand them and agree to abide by and strictly follow them.
I also understand that I may nevertheless be returned to any institution, resource, or facility of the Department of Children and Families if, in the
opinion of the Commissioner or his/her designee, it is no longer in my best interest to remain at the current placement.
Client Signature
Date
Witness Signature
Date
Distribution:
Copy to Client
Copy to Facility
Copy to Guardian
Copy to Parole Officer
Copy to Records
Department of Children and Families
JUVENILE SERVICES – EXPECTATIONS OF PLACEMENT
DCF-066
11/08 (Rev.)
Client Name:
Date of Placement:
DOB:
DOC:
Commitment End Date:
Parole Services Officer:
Phone
The Commissioner of Children and Families or his/her designee, having reviewed and considered your case, has decided to place you at:
Name of Placement:
No and Street Address:
City/Town:
State:
Zip:
Although you are not yet on parole while at this placement, you have been assigned a Parole Services Officer who will help you adjust to your
new placement and help prepare you for eventual transition to parole status. Whenever problems arise, or you do not understand what is
expected of you while in placement, you may consult with your Parole Services Officer, who will assist you.
If at any time you believe your placement is not meeting your treatment needs, you may request a Treatment Plan Hearing, by writing to the
Commissioner of DCF, specifically stating the elements of your treatment plan with which you are not in agreement. You are encouraged to
request a Treatment Plan Hearing rather than leaving a placement without permission and accruing additional charges by doing so.
EXPECTATIONS:
1.
You must obey the rules and requirements of the above-named placement and comply with treatment recommendations.
2.
You must return to the above-named placement as scheduled and at the appointed time, from any passes or furloughs,
and you must not leave the above-named placement without first obtaining permission from:
3.
You must at no time own, possess, use, sell, or have under your control any weapon or firearm.
4.
You must not use, possess or control, any illegal drug, narcotic or intoxicating substance. (marijuana, cocaine, heroin, Ecstasy, LSD, etc.).
5.
You must not use, possess, or control any form of alcoholic beverages.
6.
You must not use, possess or control any legal prescription medication unless prescribed for you by a licensed physician
7.
You must attend school and all scheduled classes. If you are suspended from school you must immediately notify your Parole Services
Officer. If you are officially withdrawn from school with parental/guardian permission, or have completed school, you must cooperate with
alternative programming or maintain employment.
8.
You must not violate any law, statute, regulation, or ordinance of the United States, State of Connecticut, any other state, county, city, town
or municipality. If you are arrested, you must notify your Parole Services Officer immediately!
9.
You must maintain contact with your Parole Services Officer and comply with the following Special requirements:
A. You must comply with random drug screening by Parole Services or its designee
B.
C.
D.
I have read, or have had read to me, the expectations and I fully understand them and agree to abide by and strictly follow them.
I also understand that I may nevertheless be returned to any institution, resource, or facility of the Department of Children and Families if, in the
opinion of the Commissioner or his/her designee, it is no longer in my best interest to remain at the current placement.
Client Signature
Date
Witness Signature
Date
Distribution:
Copy to Client
Copy to Facility
Copy to Guardian
Copy to Parole Officer
Copy to Records