Form DCF-779 "Notice at Age of Majority and Agreement for Services Post-majority (Spm)" - Connecticut

What Is Form DCF-779?

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 April 1, 2015;
  • 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 printable version of Form DCF-779 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-779 "Notice at Age of Majority and Agreement for Services Post-majority (Spm)" - Connecticut

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DCF-779
04/2015 (Rev.)
State of Connecticut
Department of Children and Families
NOTICE AT AGE OF MAJORITY
and
AGREEMENT FOR SERVICES POST-MAJORITY (SPM)
Name of Youth:
DOB:
Address:
Phone:
City, State & Zip:
LINK PID #:
Within the next three months, you will reach your 18
birthday or you have already reached your 18
birthday.
th
th
At age 18, you are no longer committed to the care and custody of the Commissioner of the Department of
Children and Families and you are not required to accept DCF services. However, you may continue to receive
services from DCF as long as you remain in good standing in accordance with the DCF Adolescent Services
Policy (Chapter 42) including participation in full-time attendance at:
a secondary (high) school
a technical school
a college
a stated-accredited job training program OR
a post-secondary employment and career development program
AND consent to remain in care by participating in services as documented in your case plan.
I WISH TO: (check all that apply)
voluntarily agree to participate in services offered by DCF as set forth in my case plan
attend a high school or technical school
attend a 2 or 4 year college
attend a certified technical/vocational program
☐ attend a state-accredited job training program
attend a post-secondary employment training program
Transfer to: ☐
Department of Mental Health and Addiction Services
Department of Developmental Services
OR ☐ leave DCF care on my 18
birthday. I understand that DCF will terminate money payments and
th
placement services on that date.
Date to review Transition Plan: ______________
Signature of Youth
Date
Signature of DCF Social Worker
Date
_______________________________________
Signature of DCF Revenue
Date
Signature of DCF Youth’s Attorney or GAL
Date
Enhancement Representative
Faxed to DCF/RED Revenue Enhancement Division at (860) 706-5331
DCF-779
04/2015 (Rev.)
State of Connecticut
Department of Children and Families
NOTICE AT AGE OF MAJORITY
and
AGREEMENT FOR SERVICES POST-MAJORITY (SPM)
Name of Youth:
DOB:
Address:
Phone:
City, State & Zip:
LINK PID #:
Within the next three months, you will reach your 18
birthday or you have already reached your 18
birthday.
th
th
At age 18, you are no longer committed to the care and custody of the Commissioner of the Department of
Children and Families and you are not required to accept DCF services. However, you may continue to receive
services from DCF as long as you remain in good standing in accordance with the DCF Adolescent Services
Policy (Chapter 42) including participation in full-time attendance at:
a secondary (high) school
a technical school
a college
a stated-accredited job training program OR
a post-secondary employment and career development program
AND consent to remain in care by participating in services as documented in your case plan.
I WISH TO: (check all that apply)
voluntarily agree to participate in services offered by DCF as set forth in my case plan
attend a high school or technical school
attend a 2 or 4 year college
attend a certified technical/vocational program
☐ attend a state-accredited job training program
attend a post-secondary employment training program
Transfer to: ☐
Department of Mental Health and Addiction Services
Department of Developmental Services
OR ☐ leave DCF care on my 18
birthday. I understand that DCF will terminate money payments and
th
placement services on that date.
Date to review Transition Plan: ______________
Signature of Youth
Date
Signature of DCF Social Worker
Date
_______________________________________
Signature of DCF Revenue
Date
Signature of DCF Youth’s Attorney or GAL
Date
Enhancement Representative
Faxed to DCF/RED Revenue Enhancement Division at (860) 706-5331