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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:

5.67

CP&P Form 5-67, Adolescent Case Closing Checklist

 

Click here to view or print the CP&P Form 5-67, Adolescent Case Closing Checklist.

 

PURPOSE AND USE

 

Use this form in conjunction with the CP&P Form 5-66, Adolescent Case Closing Agreement, to present information to an adolescent between 16 to 21 years old for whom CP&P does not have custody, when closing his or her case. The Worker obtains and/or makes copies of documents for the adolescent. 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. Note: Give the original Long Form Birth Certificate and Social Security Card to the adolescent. Make/keep copies for the case record.

 

INSTRUCTIONS FOR COMPLETING THE FORM

 

The CP&P Form 5-67 is completed by hand. The Worker:

 

1.    Reviews the checklist with the adolescent, checking item boxes and filling in dates as specified.

 

2.    Enters N/A, to the right of the item, when it is not applicable to the adolescent.

 

3.    Enters additional information at "Explain any item above."

 

The Adolescent:

 

1.    Enters his or her initials on the line to the left of each item, upon receipt of specified items, or upon discussing the topic with the Worker.

 

2.    Signs his or her name on the signature line.

 

3.    Enters the date.

 

 

The Worker:

 

1.    Signs his or her name on the signature line.

 

2.    Enters the date.

 

DISTRIBUTION

 

Original (White copy)

Case Record

Copy (Yellow copy)

Adolescent