Government Issued Identification Card

/ Tennessee Department of Children’s Services
YDC Youth Personal Portfolio Checklist
Youth’s Name: / Release Date:

The Youth Development Center (YDC) Case Manager will fill out this form to verify that the following documents are included in the youth’s personal portfolio.

Government Issued Identification Card

Social Security Card

Birth Certificate

Educational Records (not to include psychological)

Dental Records

Updated & Recent Medical Records (include immunization records)

Summary Documentation from last doctor visit

Youth’s Resume, if applicable

Letters of Recommendation

Religious Documents and Information, if applicable

Documentation of Immigration Citizenship, or Naturalization, if applicable (I-9)

Voter’s Registration Card, if applicable

Death Certificates when parents are deceased

Selective Service Number, if applicable

Certificates of Completion

Examples of Achievement (e.g. artwork, writing samples)

List of Emergency Contacts, including Team Leader and Team Coordinator

List of known relatives, and other supportive adults (contained in Genogram documents)

Other; describe specific document below in comment section.

Comments:

My signature verifies that all applicable documents were placed in the youth’s portfolio and given to the youth when he left the YDC.

YDC Case Manager / Date / Supervisor / Date

Check the “Forms” Webpage for the current version and disregard previous versions. This form may not be altered without prior approval.

Distribution: RDA 2982

CS-1043, 04/15 Page 1