ࡱ> MPL5@ 4bjbj22 *8XX ?8\(hd  &$1(1(1(1(1(1($<*R,U(9U((>>>L &> &>R>V)#@#X ?*H4i# Q$(0(u#x-|-#-#dh}J><U(U($ $($ANOTHER PLANNED PERMANENT LIVING ARRANGEMENT AGREEMENT E(Formerly Emancipation)Department of Human ServicesAnother Planned Permanent Living Arrangement-E (APPLA-E) is a plan developed for a youth that includes relationships with significant adults in their life that will continue beyond foster care. Planned means the arrangement is intended and designed. Permanent means enduring, lasting, or stable. Living arrangement, in these cases, may not include the physical placement of the child, but does involve nurturing and supportive relationships that the youth will be provided by a specified adult or adults. Multiple agreements may be entered for a youth if multiple supportive adults are involved. AGREEMENT The persons involved in this agreement believe that it is in the best interest of the youth to be in a supportive relationship with the identified adult. This agreement is being established as a statement of our mutual commitment to a permanent relationship. Although the casework support will end when the foster care case closes, it is the supportive adults intent to continue a caring relationship into the youths adulthood. By signing this agreement, the supportive adult agrees: To commit to a supportive relationship with the youth into adulthood. To be a positive role model. To provide the youth with specific support as defined in this agreement on an ongoing basis. By signing this agreement, the caseworker and assigned foster care agency, during agency supervision, agree: To maintain and support the long-term relationship of the youth with the supportive adult. To respond to requests for services and supports to ensure positive supportive relationships and stability for the youth. To ensure that the agreed upon visitation and sharing of information is provided to the siblings. To facilitate between all parties to arrange appropriate scheduling and required transportation for visitation. To respond to requests for facilitation if an issue arises between the parties. By signing this agreement, the youth agrees: To participate and cooperate in a relationship with the supportive adult. To ask the foster care worker for support and advice in dealing with issues that arise.The supportive adult agrees to provide the following supports*: FORMTEXT      Youth SignatureDate FORMTEXT      Supportive Adult SignatureDate FORMTEXT      Agency Caseworker Signature Date FORMTEXT      Foster Care Supervisor SignatureDate FORMTEXT      DHS Local County Director Sig<>XYuE F    BDXZ\fh"$}hjh$rUjfh$rUh$rjh$rUjh$rUmHnHujh;Uh;jh;Uh-0h-05 h%h% h%5h% h-bh-bh-bh-b5hlh-b h-05h-01=>XY|s6<kd$$Ifl4X0*'4 laf4 $Ifgd-b<kdX$$Ifl4X0*'4 laf4<kd$$Ifl4 X0*'4 laf4 $Ifgd-b-4Yvwxy seeeeU$ & F$Ifa$gd%$$Ifa$gd%<kd`$$Ifl4X0*'4 laf4 $Ifgd(,<kd$$Ifl4X0*'4 laf4 $Ifgd-b & K'^$ & F$Ifa$gd%$ & F$Ifa$gd%$ & F$Ifa$gd%$$Ifa$gd%$ & F$Ifa$gd%$ & F$Ifa$gd% |s6<kdh$$Ifl4X0*'4 laf4 $Ifgd-0<kd$$Ifl4X0*'4 laf4 $Ifgd(,<kd$$Ifl4X0*'4 laf44>sjj $Ifgd-0<kd$$Ifl4X0*'4 laf4 $Ifgd(,<kd4$$Ifl4X0*'4 laf4 $Ifgd;>@BjlMDD $Ifgd-0Okd$$Ifl4 0XH!0*4 laf4 $Ifgd-0 $Ifgd(,Okd$$Ifl40XH!0*4 laf4MOkdR$$Ifl4 0XH!0*4 laf4 $Ifgd-0 $Ifgd-0Okd\$$Ifl40XH!0*4 laf4 "JLMOkd$$Ifl4 0XH!0*4 laf4 $Ifgd-0 $Ifgd-0Okd$$Ifl40XH!0*4 laf4$8:<FHL, ,,,2,4,6,@,B,,,,,, - ------.444444444׳רכח|ht0JmHnHu h;0Jjh;0JUh;h(Vh;Lh-00J"j h-0Ujh-0UjF h$rUUjh$rUhh-0jh$rUmHnHujh$rUjVh$rUh$r/,,MOkdB $$Ifl4 0XH!0*4 laf4 $Ifgd-0 $Ifgd-0OkdL$$Ifl40XH!0*4 laf4natureDate FORMTEXT      * The  Permanency Pact, located at  HYPERLINK "http://www.fosterclub.com" www.fosterclub.com, may be utilized for examples of supports that are important to transitioning youth. DHS-642 (8-09) Previous edition ob,,,D,F,H,MD $Ifgd(,Okd $$Ifl4 0XH!0*4 laf4 $Ifgd-0 $Ifgd-0Okd $$Ifl40XH!0*4 laf4H,J,---4444|wnllwX^Xgd;gd(V<kde $$Ifl4X0*'4 laf4 $Ifgd-0<kd< $$Ifl4X0*'4 laf4solete. 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