Form DCF-2251 "Community Housing Assistance Program (Chap) Contract" - Connecticut

What Is Form DCF-2251?

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-2251 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-2251 "Community Housing Assistance Program (Chap) Contract" - Connecticut

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DCF-2251
04/2015 (Rev.)
DEPARTMENT OF CHILDREN AND FAMILIES
COMMUNITY HOUSING ASSISTANCE PROGRAM (CHAP) CONTRACT
This is a binding contract between the Participant
and the Department of Children and Families (DCF), currently represented by
the Adolescent Specialist.
This contract is binding during the dates listed below (which cannot exceed six months).
Future contracts shall be created and signed by all parties during Participant’s stay in the
Community Housing Assistance Program. Failure to have an up-to-date contract will
jeopardize Participant’s right to any benefits afforded through CHAP.
This contract is binding beginning
through
(Date)
(Date)
This contract is subject to change if:
(a) any part of it becomes contradictory to future policies or procedures adopted
by the Community Housing Assistance Program (CHAP);
(b) any part of it becomes contradictory to future rules, policies or procedures
enacted by governing bodies; or
(c) said change is negotiated and signed by Participant and Adolescent Specialist
and, if appropriate, the CHAP Community Case Manager.
I. Participant’s responsibilities
A. Participant will reside at the following address:
* If this address changes, or if anyone other than Participant is residing, frequenting
or sleeping in the CHAP home, Participant agrees to notify his or her Adolescent
Specialist (and Case Manager if applicable) within 72 hours.
B. Participant will attend a full time educational or vocational program regularly and
continuously.
Educational/Vocational Program
(attendance dates)
1
DCF-2251
04/2015 (Rev.)
DEPARTMENT OF CHILDREN AND FAMILIES
COMMUNITY HOUSING ASSISTANCE PROGRAM (CHAP) CONTRACT
This is a binding contract between the Participant
and the Department of Children and Families (DCF), currently represented by
the Adolescent Specialist.
This contract is binding during the dates listed below (which cannot exceed six months).
Future contracts shall be created and signed by all parties during Participant’s stay in the
Community Housing Assistance Program. Failure to have an up-to-date contract will
jeopardize Participant’s right to any benefits afforded through CHAP.
This contract is binding beginning
through
(Date)
(Date)
This contract is subject to change if:
(a) any part of it becomes contradictory to future policies or procedures adopted
by the Community Housing Assistance Program (CHAP);
(b) any part of it becomes contradictory to future rules, policies or procedures
enacted by governing bodies; or
(c) said change is negotiated and signed by Participant and Adolescent Specialist
and, if appropriate, the CHAP Community Case Manager.
I. Participant’s responsibilities
A. Participant will reside at the following address:
* If this address changes, or if anyone other than Participant is residing, frequenting
or sleeping in the CHAP home, Participant agrees to notify his or her Adolescent
Specialist (and Case Manager if applicable) within 72 hours.
B. Participant will attend a full time educational or vocational program regularly and
continuously.
Educational/Vocational Program
(attendance dates)
1
DCF-2251
04/2015 (Rev.)
C. Participant agree to accumulate 40 productive hours per week that will include:
educational or vocational program, study hours, work and any of the following activities:
counseling, volunteer and civic activities and parenting classes or groups. Additional
activities must be approved by the Adolescent Specialist.
Participant will participate in the following activities for 40 hours per week: (please break
out each activity and number of hours per activity to equal 40 hours). Ten of the 40 hours
must be dedicated to a part-time job, internship, training or apprenticeship OR an approved
volunteer opportunity.
D. Participant will apply for financial aid in a timely fashion (with assistance from
Adolescent Specialist).
E. Participant will remain in good academic standing each semester (as defined by the
educational or vocational program).
F. Participant will submit each semester’s grades and progress reports to the Adolescent
Specialist
within 72 hours of receipt.
G. Participant has completed or is enrolled in the following life skills program:
H.
Participant will deposit 50% of earned income into an interest-bearing savings
account.
Savings amount:
$
As of:
I.
Participant will meet with Adolescent Specialist at least once a month at
Participant’s residence (unless Participant attends school out of state).
J.
Participant agrees to be actively involved in the following additional activities:
2
DCF-2251
04/2015 (Rev.)
K.
Participant will inform the Adolescent Specialist within 72 hours of any major
changes in Participant’s situation including but not limited to: quitting or losing a
job, leaving an educational or training program, moving.
L.
Participant will agree to actively prepare for his or her transition from DCF care.
II. DCF Adolescent Specialist’s Responsibilities
A.
Additional Specialist may provide Participant with start-up living costs:
$
for housewares (maximum $150)
$
for food (maximum $100)
$
for furniture ($1500 maximum)
B.
Adolescent Specialist will initiate the subsidy payment each month. The current subsidy
amount is $
per month for the first
months.
C.
Adolescent Specialist may provide a one-time apartment deposit:
(first and last month's rent)
$
D.
Adolescent Specialist will provide a medical card to Participant for the duration of
Participant’s involvement in CHAP.
E.
Adolescent Specialist will meet with Participant twice a month.
One meeting will
take place in Participant’s place of residence.
F.
Adolescent Specialist will collaborate with Participant on housing, education, employment
and identifying permanent family and adult life-long connections.
G.
Adolescent Specialist and Participant will review the latter’s budget expenditures
monthly.
H.
Adolescent Specialist will monitor Participant’s school attendance.
I.
Adolescent Specialist will monitor Participant's savings account.
J.
Adolescent Specialist and Participant will review the Transitional Living Case Plan, address
issues as needed and document Participant's plan and progress towards transitioning from care
each September or more frequently.
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DCF-2251
04/2015 (Rev.)
III. General Provisions
A.
Adolescent Specialist and Participant will review this contract every three months
(unless a more frequent review is required or requested).
B.
If Participant has a Case Manager, the Case Manager’s duties shall be outlined in
Attachment A to this contract.
C.
This contract will be signed every six (6) months in as part of the Administrative Case
Review process.
IV. Additional Information
Please add any additional information, conditions or requirements here:
This agreement will be reviewed on
with Participant, Case Manager, and
Adolescent Specialist present. Participant will remain eligible for CHAP until Participant’s 23rd
birthday, or at the end of the school year when Participant turns 23 years as long as Participant
continues to meet DCF Policy criteria and remains in good academic standing.
Projected Discharge Date from CHAP:
Participant
Date
Case Manager
Date
Adolescent
Specialist
Date
Adolescent SW
Supervisor
Date
Adolescent
Program Manager
Date
4
DCF-2251
04/2015 (Rev.)
Attachment A
I. Case Manager’s Responsibilities
A.
The Participant will meet with the Case Manager weekly during this contract period,
to review and improve skills in the following areas of concern:
B. The Case Manager shall submit a monthly Case Manager’s Progress Report to the
Adolescent Specialist, the Central Office Adolescent Services representative and the
Central Office Credentialing Unit.
Participant
Date
Case Manager
Date
Adolescent
Date
Specialist
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