______
NameDate of Birth
______
Date of NoticeEffective Date of Termination
After reviewing your overall compliance with the goals set forth in your Aftercare Services Plan, your case manager and case manager’s supervisor have determined that you are no longer eligible for Aftercare Services, and therefore, you will no longer receive any of the benefits available through Aftercare Services.
Please review this notice carefully as it outlines the reason(s) for this decisionand your right to request a fair hearing if you disagree with this decision. This notice also includes a brief description of other services that may be available, which you may discuss with your case manager.
REASONS FOR TERMINATION FROM AFTERCARE
_____You are not in compliance with the agreed upon tasks toward meeting the goals in your Aftercare ServicesPlan. Your areas of noncompliance are: ______
OTHER: ______
______
______
HOW TO CHALLENGE, OR CONTEST, THIS DECISION TO DISCHARGE YOU FROM THE AFTERCARE PROGRAM
If you wish to challenge or contest any of the information above, you have the right to do so. As described below, you can request a fair hearing through the Department of Children and Families.
Request a Fair Hearing. This is a formal procedure in which the Department of Children and Families will have a legal representative. You can present your case yourself or have legal counsel or a representative present your case. If you want to have a fair hearing, you must request one within 30 days of receiving this notice. If you want to continue to receive Aftercare Services pending completion of the fair hearing process, you must request a fair hearing within 10 days of receiving this notice. If the last day to request a fair hearing falls on a weekend or holiday, the request will be considered timely if it is sent the first business day after the deadline. The best way to ask for a fair hearing is by using the “Request for Fair Hearing on Application Denial or Discharge from the Extended Foster Care Program; or on Denial, Termination or Reduction of Postsecondary Education Services and Support or Aftercare Services Benefits,” CF-FSP 5380, August 2014. That form is attached. You can also talk to your case manager to tell him or her you want a fair hearing. The same time frames apply.
OTHER SERVICES YOU MAY BE ELIGIBLE FOR
Extended Foster Care (EFC). You can re-apply for EFC at any time, if you are under age 21. You must meet the eligibility requirements, which include participating in or being willing to participate in school, work or other programs as set forth in section 39.6251(2), Florida Statutes. There is NO limit on the number of times you can leave or be discharged from the program, and re-enter the program if you are eligible to participate.
Aftercare Services. You may apply or re-apply for Aftercare Services, which are temporary supports and services available to help you during your transition to independence. Aftercare Services can help you get set up for living independently.
Postsecondary Education Services and Support (“PESS”). You can apply or re-apply for PESS at any time, if you have not yet reached 23 years of age. You must meet the eligibility requirements, which include having a high school diploma, GED, or its equivalent and maintaining enrollment in a Bright Futures-eligible college or other postsecondary institution for at least 9 credit hours.
Your case manager will have additional information to help you make a decision about these services.
Case Manager:
______
Name (Print)SignatureDate
______
Address
______
Phone Email
Case Manager’s Supervisor:
______
Name (Print)SignatureDate
______
Phone Email
To be completed by the young adult if notice is hand-delivered:
I acknowledge that I have received notice of my discharge from Aftercare Services, as well as my rights to dispute this decision and the available processes. I also have received information about other programs. I understand that it is now my responsibility to contact my case manager to ask for help with the appeals process, and to ask for information and help in applying for other services which may be available to me.
______
Young Adult’s SignatureDate
Attachments: CF-FSP 5379 Due Process Rights for Young Adults Formerly in Foster Care
CF-FSP 5380 Request for Fair Hearing on Application Denial or Discharge from the Extended Foster Care Program; or on Denial, Termination or Reduction of Postsecondary Education Services and Supportor Aftercare Services Benefits
[A copy of this signed notice and the attachments cited above shall be provided to the young adult by the case manager.]
CF-FSP 5402, February 2015Page 1 of 3
65C-42.004