Form KDOC-0110 "Standardized Orientation Checklist" - Kansas

What Is Form KDOC-0110?

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

Form Details:

  • Released on October 1, 2012;
  • The latest edition provided by the Kansas Department of Corrections;
  • 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 KDOC-0110 by clicking the link below or browse more documents and templates provided by the Kansas Department of Corrections.

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Download Form KDOC-0110 "Standardized Orientation Checklist" - Kansas

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STANDARDIZED ORIENTATION CHECKLIST
*The youth and parent/guardian should initial each item.
Youth
Parent/Guardian
Date
Initials
Initials
Reviewed
Reviewed and gave copies of supervision requirements, programmatic
goals, objectives, violations, regulations, contact requirements and any
other local information with the youth and parent(s)/guardian(s) and
answered any questions presented during the discussion.
Reviewed specific court orders/conditions of assignment with the youth
and parent(s)/guardian(s) and answer any questions presented during the
discussion.
Discussed any fees associated with the program and/or community
service work (CSW) requirements and made resources available to
complete CSW.
Reviewed the Appeal/Grievance Policy and provide the youth and
parent(s)/guardian(s) with the copy.
Reviewed the Agency’s confidentiality guidelines/policy.
Reviewed and obtained signatures on the Release of Information form
(KDOC-0088).
Reviewed and obtained signatures on the Medical Consent form (KDOC-
0092 or KDOC-0093). Only for custody youth.
Reviewed and obtained signatures on the JS Acknowledgement of
Parental Obligation (KDOC-0014). Only for custody youth.
Determine if the youth is receiving Social Security Benefits. Only for
custody youth.
Gather information required and complete the DCF PPS5410A for Initial
Title IV-E Eligibility Determination. Only for custody youth.
Reviewed and obtained signatures on the KSDE/FERPA 001 and CFS
4003 forms. Only for custody youth.
Obtain copies of health insurance, social security card and birth certificate. Only for custody youth.
By signing below, I acknowledge that I have completed the orientation process, received a copy of the supervision
conditions and understand the information where I initialed in the checklist above.
Juvenile Signature
Date
Parent/Guardian Signature
Date
Community Supervision Officer
Date
State of Kansas
Kansas Department of Corrections
Form: KDOC-0110
Revised: October 2012
STANDARDIZED ORIENTATION CHECKLIST
*The youth and parent/guardian should initial each item.
Youth
Parent/Guardian
Date
Initials
Initials
Reviewed
Reviewed and gave copies of supervision requirements, programmatic
goals, objectives, violations, regulations, contact requirements and any
other local information with the youth and parent(s)/guardian(s) and
answered any questions presented during the discussion.
Reviewed specific court orders/conditions of assignment with the youth
and parent(s)/guardian(s) and answer any questions presented during the
discussion.
Discussed any fees associated with the program and/or community
service work (CSW) requirements and made resources available to
complete CSW.
Reviewed the Appeal/Grievance Policy and provide the youth and
parent(s)/guardian(s) with the copy.
Reviewed the Agency’s confidentiality guidelines/policy.
Reviewed and obtained signatures on the Release of Information form
(KDOC-0088).
Reviewed and obtained signatures on the Medical Consent form (KDOC-
0092 or KDOC-0093). Only for custody youth.
Reviewed and obtained signatures on the JS Acknowledgement of
Parental Obligation (KDOC-0014). Only for custody youth.
Determine if the youth is receiving Social Security Benefits. Only for
custody youth.
Gather information required and complete the DCF PPS5410A for Initial
Title IV-E Eligibility Determination. Only for custody youth.
Reviewed and obtained signatures on the KSDE/FERPA 001 and CFS
4003 forms. Only for custody youth.
Obtain copies of health insurance, social security card and birth certificate. Only for custody youth.
By signing below, I acknowledge that I have completed the orientation process, received a copy of the supervision
conditions and understand the information where I initialed in the checklist above.
Juvenile Signature
Date
Parent/Guardian Signature
Date
Community Supervision Officer
Date
State of Kansas
Kansas Department of Corrections
Form: KDOC-0110
Revised: October 2012