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NJ DCF Logo with reverse copy

 

New Jersey Department of Children and Families Policy Manual

 

Manual:

CP&P

Child Protection and Permanency

Effective Date:

Volume:

X

Forms

Chapter:

A

Forms

8-13-2007

Subchapter:

1

Forms

Issuance:

5.66

CP&P Form 5-66, Adolescent Case Closing Agreement

 

 

Click here to view or print the CP&P Form 5-66, Adolescent Case Closing Agreement.

 

PURPOSE AND USE

 

Use this form in conjunction with the CP&P Form 5-67, Adolescent Case Closing Checklist. This agreement allows the Worker to review and document a discussion held with the adolescent about limitations on service eligibility, once his or her CP&P case is closed. The form allows the adolescent to give a written explanation and documentation as to why he or she would like his or her CP&P case closed. The form cannot be used/does not apply when CP&P has custody of the child or when the adolescent is receiving services based on child abuse/neglect.

 

INSTRUCTIONS FOR COMPLETING THE FORM

 

The CP&P Form 5-66 is completed by hand. The Worker:

 

1.    Enters additional specialized services and/or payments that the adolescent will not be entitled to once his or her case is closed.

 

2.    Reviews the closing agreement with the adolescent.

 

 

3.    Helps the adolescent to articulate his or her thoughts and reasons for requesting case closure.

 

The Adolescent:

 

1.     Writes why he or she would like his or her CP&P case to be closed.

 

2.     Signs his or her name on the signature line, and dates the signing.

 

The Worker:

 

1.    Witnesses the adolescent's completion of the form by signing his or her name on the signature line, and dating the signing.

 

DISTRIBUTION

Original (White)

Case Record

Copy (Yellow)

Adolescent

Copy

CPRB, Law Guardian, Independent Living Placement, or Contract Agencies, as appropriate