Form CFS374-1 "Emancipation Funding Application and Disbursement Plan" - Illinois

What Is Form CFS374-1?

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 June 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 CFS374-1 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 CFS374-1 "Emancipation Funding Application and Disbursement Plan" - Illinois

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CFS 374-1
06/2014
State of Illinois
Department of Children and Family Services
EMANCIPATION FUNDING APPLICATION AND DISBURSEMENT PLAN
This version is only to be used for Youth turning 21 in July, August & September 2014
DCFS Case ID:
Name:
Birth Date:
/
/
SSN:
Date of Expected Emancipation:
/
/
Address (Needs to be a current address for the next 60 days for payment to be received):
Street:
City:
State:
Zip:
In order to be eligible to apply/receive Emancipation Funding, all of the following criteria must be met.
For payment to be processed, all check boxes must be marked “completed”, and full signatures below.
Youth is in a Department approved substitute care placement.
CFS 2032-1 Youth Driven Transition Plan or CFS 375-2 Quarterly Discharge Launch Plan completed.
Youth has identified a supportive resource person.
Disbursement Plan Amount of $_________________ from page 2, verified and approved.
The signatures below indicate agreement and verification that all criteria checked above have been met.
Caseworker:
Signature:
Date:
/
/
Supervisor:
Signature:
Date:
/
/
Send signed and completed transition plan, application and budget forms to DCFS Division of
Support Services for processing via fax to 312/814-9408.
1
CFS 374-1
06/2014
State of Illinois
Department of Children and Family Services
EMANCIPATION FUNDING APPLICATION AND DISBURSEMENT PLAN
This version is only to be used for Youth turning 21 in July, August & September 2014
DCFS Case ID:
Name:
Birth Date:
/
/
SSN:
Date of Expected Emancipation:
/
/
Address (Needs to be a current address for the next 60 days for payment to be received):
Street:
City:
State:
Zip:
In order to be eligible to apply/receive Emancipation Funding, all of the following criteria must be met.
For payment to be processed, all check boxes must be marked “completed”, and full signatures below.
Youth is in a Department approved substitute care placement.
CFS 2032-1 Youth Driven Transition Plan or CFS 375-2 Quarterly Discharge Launch Plan completed.
Youth has identified a supportive resource person.
Disbursement Plan Amount of $_________________ from page 2, verified and approved.
The signatures below indicate agreement and verification that all criteria checked above have been met.
Caseworker:
Signature:
Date:
/
/
Supervisor:
Signature:
Date:
/
/
Send signed and completed transition plan, application and budget forms to DCFS Division of
Support Services for processing via fax to 312/814-9408.
1
Plan for Intended Use of Emancipation Funds
The purpose of Emancipation Funding is to provide financial support to youth as they leave the child
welfare system and become self-sufficient. The Department will authorize payment only if the youth is in
compliance with the checked criteria on Page 1. Please provide amounts planned for the categories
below, which will equal the total emancipation fund amount to be paid to the youth.
Budget Category
Amount to be Disbursed
Housing (e.g. rent, security deposit)
Education Related Expenses
Transportation
Medical/Health
Daycare/Childcare
Furniture (electronics not included)
Debt Reduction
Savings Account Deposit
Total of category amounts must equal approved disbursement total entered on Page
1.
Youth’s signature below reflects they intend to utilize the emancipation funds according to
the budgeted amounts listed above.
Youth Signature:
Date:
/
/
2
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