Form CFS370-5YHAP "Youth Housing Assistance Program Request for Cash Assistance and/or Housing Advocacy" - Illinois

What Is Form CFS370-5YHAP?

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

Form Details:

  • Released on July 1, 2014;
  • The latest edition provided by the Illinois Department of Children and Family Services;
  • 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 CFS370-5YHAP by clicking the link below or browse more documents and templates provided by the Illinois Department of Children and Family Services.

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Download Form CFS370-5YHAP "Youth Housing Assistance Program Request for Cash Assistance and/or Housing Advocacy" - Illinois

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CFS 370-5YHAP
State of Illinois
Rev 7/2014
Department of Children and Family Services
YOUTH HOUSING ASSISTANCE PROGRAM
CASH ASSISTANCE OR HOUSING ADVOCACY
TYPE OF SERVICE REQUESTED
Youth Housing Advocacy
Youth Cash Assistance
Youth Partial Housing Subsidy
CLIENT INFORMATION
Youth:
CYCIS:
Birth Date:
Address:
Phone: (
)
Email:
Region:
Site:
Field:
Other Adult:
Birth Date:
Other Adult:
Birth Date:
Child’s Name
Child Resides
Birth Date
Relation to Head
Expected Return
With
of Household
Home Date
Household Income Sources:
Amount:
Describe the issue that led to this referral:
Describe why the youth faces this issue:
What will keep the youth stable in the future?
CASEWORKER INFORMATION
Caseworker:
Worker ID#:
Agency:
Phone: (
)
Address:
Extension:
Fax: (
)
Supervisor:
Phone: (
)
Supervisor Signature:
Date:
SIGNATURES AUTHORIZING HOUSING ADVOCACY SERVICES
 Assist Client Obtain New Housing
 Stabilize Family in Current Housing
Choose One Box:
YHA Coordinator
_______________________________________
Date: ___________________________
CFS 370-5YHAP
State of Illinois
Rev 7/2014
Department of Children and Family Services
YOUTH HOUSING ASSISTANCE PROGRAM
CASH ASSISTANCE OR HOUSING ADVOCACY
TYPE OF SERVICE REQUESTED
Youth Housing Advocacy
Youth Cash Assistance
Youth Partial Housing Subsidy
CLIENT INFORMATION
Youth:
CYCIS:
Birth Date:
Address:
Phone: (
)
Email:
Region:
Site:
Field:
Other Adult:
Birth Date:
Other Adult:
Birth Date:
Child’s Name
Child Resides
Birth Date
Relation to Head
Expected Return
With
of Household
Home Date
Household Income Sources:
Amount:
Describe the issue that led to this referral:
Describe why the youth faces this issue:
What will keep the youth stable in the future?
CASEWORKER INFORMATION
Caseworker:
Worker ID#:
Agency:
Phone: (
)
Address:
Extension:
Fax: (
)
Supervisor:
Phone: (
)
Supervisor Signature:
Date:
SIGNATURES AUTHORIZING HOUSING ADVOCACY SERVICES
 Assist Client Obtain New Housing
 Stabilize Family in Current Housing
Choose One Box:
YHA Coordinator
_______________________________________
Date: ___________________________
REQUEST FOR CASH ASSISTANCE – Page two
CFS 370-5YHAP
Rev 7/2014
Page One and Two Required for Cash Assistance Requests
Youth:
CYCIS #:
CASH ASSISTANCE REQUESTED
1. Payee:
Amount:
Purpose:
Account #:
Address
Phone: (
)
Picked Up
Mailed to:
2. Payee:
Amount:
Purpose:
Account #:
Address
Phone: (
)
Picked Up
Mailed to:
3. Payee:
Amount:
Purpose:
Account #:
Address
Phone: (
)
Picked Up
Mailed to:
4. Payee:
Amount:
Purpose:
Account #:
Address
Phone: (
)
Picked Up
Mailed to:
5. Payee:
Amount:
Purpose:
Account #:
Address
Phone: (
)
Picked Up
Mailed to:
SIGNATURES OF PERSONS REQUESTING CASH ASSISTANCE
Case Worker:
________________________________________________
Date: _____________________________
Supervisor:
________________________________________________
Date: _____________________________
Signature of person who will pick up the check(s):
____________________________________________________
Sign again after the check(s) is received from the provider:
SIGNATURES AUTHORIZING CASH ASSISTANCE
1. Payee:
________________________________________________
Amount: __________________________
2. Payee:
________________________________________________
Amount: __________________________
3: Payee:
________________________________________________
Amount: __________________________
4. Payee
________________________________________________
Amount: __________________________
5. Payee
________________________________________________
Amount: __________________________
YHA Coordinator ______________________________________________
Date: _____________________________
Page of 2