Form 30237 - Invoice For Youth Graduation Award - South Carolina Department Of Social Services

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South Carolina Department of Social Services
Independent Living Program
INVOICE FOR YOUTH GRADUATION AWARD
Select County ...
1. County:
2. Regional Office:
3. Case Manager:
4. Youth’s Name:
n
n
n
n
5. Sex:
Male
Female
6. Race:
7. Date of Birth:
n
n
8.
Please mail the Graduate Award to the youth in care of (c/o):
The c/o name is:
Street Address:
City, State, Zip:
Name of School:
Note: A printout of the CAPSS “Education Screen” MUST accompany this Graduate Award Invoice
n
n
Educational Award Earned:
CAPSS Education Screen is attached
n
n
High School Diploma
n
n
Certificate of Completion
n
n
Adult Education/GED
n
n
Associate’s Degree
n
n
Vocational Certificate
n
n
Bachelor’s Degree
n
n
Master’s Degree
Date Educational Award Earned:
Signature of Youth
Date
Amount Due:
(To be completed by State Office)
Signature of Independent Living Coordinator
Date
Approved by:
Date:
DSS Form 30237 (JUL 11) Edition of APR 08 is obsolete.

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