ࡱ> '` ERrbjbj{P{P .::lF(P;P;P;8x]<]D&T;x=x=x=x=S>@?G@\Q$+S+S+S+S+S+S$Uh@X(OSu@S>S>@@OSx=x=S&CCC@Xx=x=QC@QCC:I,9Jx=^ P;@XI CKS<&TIRhYSA hY9JhYGJ@@C@@@@@OSOSsC@@@&T@@@@"" Child s NameCERTIFICATION OF GUARDIANSHIP ASSISTANCE FORMTEXT      ELIGIBILITY AND REQUEST FOR AGREEMENTState and Title IV-E Funded Juvenile GuardianshipsChild s BirthdateSWSS Log NumberMichigan Department of Human Services FORMTEXT       FORMTEXT      Child s Legal Status: FORMCHECKBOX Permanent Court Ward FORMCHECKBOX State Ward (MCI) FORMCHECKBOX Temporary Court WardWorker s Certification of Guardianship Eligibility RequirementsA.All of the following are documented in the foster care case record (check each one that applies): FORMCHECKBOX The child demonstrates a strong attachment to the prospective guardian. FORMCHECKBOX The child has been consulted about guardianship if age 14 or older. FORMCHECKBOX The child is under age 18 (birth certificate is in the file). FORMCHECKBOX Reunification and/or adoption have been ruled out as permanency goals for the child.  FORMCHECKBOX Placement with the guardian is in the child s best interest. FORMCHECKBOX The child was placed in the caregiver s home by the department as a foster child. FORMTEXT      (Date of placement) FORMCHECKBOX The prospective guardian is a licensed foster parent.Provider number: FORMTEXT       FORMCHECKBOX All adult household members have successfully completed a criminal history check and child abuse registry check, per foster care licensing requirements. FORMCHECKBOX The child is residing with the prospective guardian in the guardians licensed foster home. FORMCHECKBOX The guardian has a strong commitment to caring permanently for the child.B.The number of consecutive months the child has resided in the home of the prospective guardian: FORMTEXT      C.The prospective guardian home has been licensed for foster care since (mm/dd/yyyy): FORMTEXT      D. FORMCHECKBOX The child: Is eligible for Title IV-E foster care maintenance payments. Has lived with a prospective relative guardian for 6 consecutive months. The prospective relative guardian has been a licensed foster care provider for the 6 consecutive months the child lived with the guardian.or FORMCHECKBOX The child is NOT a title IV-E eligible child being placed with a relative guardian. E.Is this child being placed in guardianship with a sibling(s)? 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