Form CFS375-1 "Ilo/Tlp Request for Extension of Services" - Illinois

What Is Form CFS375-1?

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 November 1, 2011;
  • 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 CFS375-1 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 CFS375-1 "Ilo/Tlp Request for Extension of Services" - Illinois

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CFS 375-1
Rev. 11/2011
State of Illinois
Department of Children and Family Services
ILO/TLP Request for Extension of Services
Youth’s Name:
Date of Birth
(less than 22
years of age).
My caseworker is
, whose phone number is
.
My caseworker believes that I am capable to plan toward my emancipation.
I understand that I must complete or make reasonable progress toward completion of these tasks in order
to make a successful transition out of Child Welfare to independence. If I do not make reasonable
progress, or if my actions or inactions indicate that I am unwilling to cooperate with my caseworker or be
subject to the Department’s authority, services and financial assistance provided by the Department shall
be terminated.
I have established the following objectives for this 30-day period. Completing this will make me more
prepared for emancipation.
(INSERT LIST OF OBJECTIVES AND TASKS HERE – should be written to reflect a 30 day term)
Page 1 of 5
CFS 375-1
Rev. 11/2011
State of Illinois
Department of Children and Family Services
ILO/TLP Request for Extension of Services
Youth’s Name:
Date of Birth
(less than 22
years of age).
My caseworker is
, whose phone number is
.
My caseworker believes that I am capable to plan toward my emancipation.
I understand that I must complete or make reasonable progress toward completion of these tasks in order
to make a successful transition out of Child Welfare to independence. If I do not make reasonable
progress, or if my actions or inactions indicate that I am unwilling to cooperate with my caseworker or be
subject to the Department’s authority, services and financial assistance provided by the Department shall
be terminated.
I have established the following objectives for this 30-day period. Completing this will make me more
prepared for emancipation.
(INSERT LIST OF OBJECTIVES AND TASKS HERE – should be written to reflect a 30 day term)
Page 1 of 5
Attach additional sheets if needed
Page 2 of 5
I acknowledge that these are my objectives as I prioritized them, and that it is my responsibility to prepare
myself for independence. I understand that the Illinois Department of Children and Family Services has
contracted with
(agency name)
to assist me in this process. This agency is available to help me accomplish my goals, support my efforts,
and provide me with some financial assistance in order to promote me toward the goal of independence.
I understand that I must make reasonable progress toward the goal of independence. Reasonable progress
is defined as addressing the objectives and tasks I have set out above on a daily and/or weekly basis. If I
do not demonstrate reasonable progress toward independence within 30 days, or if my actions or inactions
indicate that I am unwilling to cooperate with my caseworker or be subject to the Department’s authority,
my case will be closed and services and financial assistance provided by the Department will be
terminated.
I have the following concerns or needs that I want to address or to have help with as part of this
contract (attach additional pages as needed):
Date
Case ID
Youth’s Signature
Date
Caseworker’s Signature
Date
ILO/TLP Casework Supervisor
I recommend a 30 day extension of ILO/TLP services for the above named youth.
Date
DCFS Monitoring Supervisor’s Signature
Page 3 of 5
On this page, the ILO/TLP Supervisor must outline or describe the youth’s accomplishments to
support a second or subsequent request for 30 day extension:
Attach additional sheets if needed
Page 4 of 5
30 Day Extension of ILO/TLP Services:
Date:
Granted
Denied
Date
Deputy Director’s Signature
30 Day Extension of ILO/TLP Services:
Date:
Granted
Denied
Date
Deputy Director’s Signature
30 Day Extension of ILO/TLP Services:
Date:
Granted
Denied
Date
Deputy Director’s Signature
Page 5 of 5
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