Form DCF-2252 "Community Housing Employment Enrichment (Cheer) Conract" - Connecticut

What Is Form DCF-2252?

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-2252 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-2252 "Community Housing Employment Enrichment (Cheer) Conract" - Connecticut

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DCF-2252
04/2015 (Rev.)
DEPARTMENT OF CHILDREN AND FAMILIES
COMMUNITY HOUSING EMPLOYMENT ENRICHMENT (CHEER)
CONRACT
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 Employment Enrichment Program.
Failure to have an up-to-date contract will jeopardize Participant’s right to any
benefits afforded through CHEER.
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 Employment Enrichment Program
(CHEER);
(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 CHEER 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)
C. Participant shall be eligible for a monthly subsidy payment in the amount of
$
for so long as Participant is in compliance with DCF CHEER
program rules and policy and with this contract. The subsidy shall be calculated
as set forth on Attachment A.
1
DCF-2252
04/2015 (Rev.)
DEPARTMENT OF CHILDREN AND FAMILIES
COMMUNITY HOUSING EMPLOYMENT ENRICHMENT (CHEER)
CONRACT
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 Employment Enrichment Program.
Failure to have an up-to-date contract will jeopardize Participant’s right to any
benefits afforded through CHEER.
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 Employment Enrichment Program
(CHEER);
(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 CHEER 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)
C. Participant shall be eligible for a monthly subsidy payment in the amount of
$
for so long as Participant is in compliance with DCF CHEER
program rules and policy and with this contract. The subsidy shall be calculated
as set forth on Attachment A.
1
DCF-2252
04/2015 (Rev.)
D. Participant agrees to accumulate 40 productive hours per week that will include:
employment training and work hours. Additional activities must be approved by
DCF 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).
E. If available, Participant shall apply for financial aid in a timely fashion (with the
assistance of the Adolescent Specialist).
F. Participant shall remain in good standing as defined by the program.
G. Participant shall be employed full time and/or participate in an approved
employment training program regularly and continuously.
H. Participant shall submit progress reports from the employment program to the
Adolescent Specialist within 72 hours of receipt.
I. Participant has completed or is enrolled in the following life skills Program:
J.
Participant shall deposit 50% of earned income into an interest-bearing savings
account during the first nine months of the CHEER Program
Savings amount:
$
As of:
Participant shall continue to save and prepare for Participant’s transition from
care while participating in the CHEER program.
K. Participant shall begin to assume a portion of the cost of Participant’s care at
month 10, utilizing earnings from employment. Participant shall receive 75% of
the monthly subsidy as of month 10, 50% as of month 13 and 25% as of month
16. (If the Participant is approved for a volunteer service year, the Participant
shall be exempt from the subsidy reduction.)
Month 10 through month 12 (25% subsidy reduction) $
(new subsidy)
Month 13 through month 15 (50% subsidy reduction) $
(new subsidy)
Month 16 through month 18 (75% subsidy reduction) $
(new subsidy)
L. Participant will meet with the Adolescent Specialist at least once a month at
Participant’s residence (unless Participant attends school out of state).
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DCF-2252
04/2015 (Rev.)
M. Participant agrees to be actively involved in the following additional activities:
N.
Participant shall inform the Adolescent Specialist within 72 hours of any major
changes in Participant’s her situation including but not limited to quitting or losing
a job, leaving a training program or moving.
O.
Participant shall agree to actively prepare for Participant’s transition from care.
P.
Failure to follow the terms set forth in this contract may result in termination from
the CHEER Program.
Participant shall have a right to a fair hearing prior to
termination.
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 shall initiate the subsidy payment each month.
C.
Adolescent Specialist may provide a one-time apartment deposit
(first and last months’ rent): $
D.
Adolescent Specialist shall provide a medical card to the Participant for the duration of
Participant’s involvement in CHEER.
E.
Adolescent Specialist shall meet with Participant twice a month. One meeting will take
place in Participant’s place of residence.
F.
Adolescent
Specialist
shall
collaborate
with
Participant
on
housing,
education,
employment and identifying permanent family and adult life-long connections.
G.
Adolescent Specialist, with Participant, shall review Participant’s budget expenditures
monthly.
H. Adolescent Specialist will monitor and document Participant's savings and subsidy reduction
requirements.
I. Adolescent Specialist will monitor Participant's employment and training attendance.
3
DCF-2252
04/2015 (Rev.)
J.
Adolescent Specialist, with Participant, shall 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.
K.
This contract will be reviewed every three months (unless a more frequent review is
required or requested) with Participant (and Case Manager if involved) present.
L.
This contract will be re-signed every six months as part of the Administrative Case Review
process or when DCF adopts new subsidy calculations.
III. General Provisions
A. If there is a Case Manager for Participant’s case, the Case Manager’s
responsibilities are set forth on Attachment B to this contract.
B. Please add any additional requirements, conditions, information and agreements:
This agreement will be reviewed on
with Participant, Case Manager, and
Adolescent Specialist present.
Participant will remain eligible for CHEER 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 CHEER:
Participant
Date
Case
Date
Manager
Adolescent
Date
Specialist:
Adolescent
Date
SW
Supervisor
Program
Date
Manager
4
DCF-2252
04/2015 (Rev.)
ATTACHMENT A: BUDGET
Participant will receive a monthly stipend based on the following budgeted allotment.
*If applicable, a subsidy paid for Participant’s child(ren) will be paid as a separate amount.
Rent
$
Utilities
$
Heat (if not included in the rent and when added
$
to rent, cannot exceed rental amount allowed for
area contained in policy)
Food
$
Telephone
$
Transportation
$
Personal Care
$
Clothing
$
SUB TOTAL
$
TOTAL MONTHLY COST
$
Participants total funding need for rent and
TOTAL
$
stipend
Present amount for subsidy during this
$
contract time period after reducations.
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