Fill - Free fillable 90-DAY TRANSITION PLAN This form is for you (California) PDF form

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES

CWS/CMS CASE MANAGEMENT

90-DAY TRANSITION PLAN

This form is for you to develop a plan when you are within 90 days of leaving foster care. This plan will

focus on activities that you will complete during this time. This is as an agreement between you and

those supporting you to work toward completing your transition plan. This should be developed with you

in a transition conference setting, or group meeting, with those you want involved and who are helping

you to successfully transition out of foster care.

Instructions To Youth: During the 90-day period before you leave foster care, you will make a

transition plan that shows where you plan to live, receive additional support, work and/or go to school

after you leave care and help keep family connections. The purpose of this plan is to help you take

steps to successfully live on your own.

Instructions to Caregiver/other adults: If asked by the youth, you are also agreeing to assist the

youth in the development of a 90-day transition plan that will help him/her to successfully transition

out of foster care.

Instructions to Social Worker/Probation Officer: During the 90-day period prior to the youth

exiting foster care, you are agreeing to assist the youth in developing a transition plan that will

address his/her needs for housing, employment, education, mentors, continuing support services

and health insurance.

Instructions for Family, Service Providers, CASA and others connected to and supporting

the youth: If asked by the youth, you are also agreeing to assist the youth in the development of a

90-day transition plan that will help him/her to successfully transition out of foster care.

During the 90-day period prior to aging out of care:

This plan is to be completed within the 90 day period before you turn 18, or exit foster care after age

18. If you emancipate from care before age 18, this plan should be completed within 90 days

before your target emancipation date.

The sections on the next page must be completed to include your plan for education, employment,

housing, mentoring, family connections, continuing support services and health insurance. The plan

must be personal to you and as detailed as you can get. The plan must contain specific actions that

you and others will take to help you prepare for leaving care.

*Note: The last page of this form has an example grid that can give you ideas to help make your

planning very concrete.

Copies to: Youth - Caregiver - Case File - ILP - Family - Others

FC 1637 (5/14) PAGE 1 OF 4

YOUTH: DOB:

AGE:

ETHNICITY:

CASE WORKER NAME: CASE WORKER PHONE:

90-DAY TRANSITION PLAN

Additional boxes can be inserted if needed

Education Plan:

To prepare, I or a supporting

adult (name) will:

Recommended documents

the youth will need

Employment Plan:

To prepare, I or a supporting

adult (name) will:

Recommended documents

the youth will need

Housing Plan:

To prepare, I or a supporting

adult (name) will:

Recommended documents

the youth will need

Mentoring & Continuing Support Services (e.g.

mental health, health services) Plan:

To prepare, I or a supporting

adult (name) will:

Recommended documents

the youth will need

Family and Other Permanent Connections:

I plan to stay connected to

family and other adults by:

Recommended documents

the youth will need

Health Insurance Plan:

If not eligible for extended

Medi-Cal, I plan to get

health insurance through:

Agency, employer or other

person providing

health insurance:

Copies to: Youth - Caregiver - Case File - ILP - Family - Others

FC 1637 (5/14) PAGE 2 OF 4

ACKNOWLEDGEMENTS:

I know that I must sign verification paperwork to continue my Medi-Cal health insurance benefits when

I exit from foster care and again each year to receive Medi-Cal until my 26th birthday or until I have

secured a different type of health insurance. I am also aware that when I move I must resubmit a

verification form with my new address. ______ youth’s initials

I have been told that when I am 18, I can choose a “power of attorney for health care” that can make

medical choices for me if I am not able. When I turn 18, I will receive directions and a form that I can fill

out if I want to choose a power of attorney for health care. ______ youth’s initials

I know that 30 days prior to leaving foster care, I am eligible to apply for food stamps. _____ youth’s

initials

I agree to meet with my caregiver and social worker/probation officer as needed to ensure sufficient

progress towards my goals.

Target date for exiting foster care ______________

By signing below, this means we will all work to complete the steps necessary to help the youth

complete his/her transition plan.

Youth’s signature Date

Caregiver’s signature Date

Social Worker/Probation Officer signature Date

Family Member signature Date

Service Providers/Therapist signature Date

CASA/Other Youth Advocates signature Date

LEGISLATIVE & REGULATORY REFERENCES:

• Public Law (P.L.) 110-351, which states that a Transition Plan must be developed at the

direction of the youth during the 90 day period prior to the youth aging out. The plan

must contain specific options on housing, health insurance, education, local

opportunities for mentors/continuing support services and workforce

support/employment services. P.L. 111-148 requires providing foster youth with the

information about a Power of Attorney for Health Care.

Copies to: Youth - Caregiver - Case File - ILP - Family - Others

FC 1637 (5/14)

PAGE 3 OF 4

90-DAY TRANSITION PLAN EXAMPLES

Education Goals:

I plan to attend….

TimeLine

FAFSA due: 01/01/2009

School application 01/15/2009

Scholarship app: 02/01/2009

Housing app: 03/01/2009

(Due dates of all document and

application deadlines)

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Fillable 90-DAY TRANSITION PLAN This form is for you (California)

Fill Online, Printable, Fillable, Blank 90-DAY TRANSITION PLAN This form is for you (California) Form

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