Form Soc 163 - Voluntary Re-Entry Agreement For Extended Foster Care
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2STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
VOLUNTARY RE-ENTRY AGREEMENT FOR EXTENDED FOSTER CARE
I have met with a county case worker (social worker or probation officer) to talk about voluntarily re-entering foster care as
an adult former foster youth who is under age 21. By signing this agreement, I understand I am voluntarily agreeing to
re-enter foster care placement.
I agree to be placed in a supervised foster care setting (such as a foster home, relative’s home, foster family agency
home, short-term residential therapeutic program (STRTP) or group home, transitional housing program, a supervised
independent living placement or with my juvenile court appointed nonrelated legal guardian), as described in my
Placement Agreement under the placement and care responsibility of
the _________________County ____________________ department.
I understand that my Aid to Families with Dependent Children – Foster Care (AFDC-FC) benefits will begin to be paid as
of the date I sign this agreement or the date I am placed in a supervised foster care setting, whichever is later.
I understand that I am responsible for completing, with assistance from my county case worker, the application for
AFDC-FC payments and providing information and documentation about my status as a former dependent child or ward of
the juvenile court, and my current income and assets, as required, as a child-only case.
I agree to participate with my county case worker in filing a petition in juvenile court so that the court may resume
jurisdiction over my case by finding that it is in my best interests to re-enter foster care.
I agree to work collaboratively with my county case worker to develop my transitional independent living case plan and
Transitional Independent Living Plan (TILP) within 60 days of signing this agreement.
I understand the benefits of re-entering foster care include having safe and stable housing and having help from a county
case worker to meet my needs and plan for my future.
___ I agree to meet face to face with my county case worker at least once a month and update my permanency
goals and my TILP at least once every six months.
___ I agree to immediately begin to do one or more of the following to be eligible to re-enter foster care:
1.
Finish high school or get my California High School Equivalency Certificate (GED), or
2.
Enroll in college, community college or a vocational education program, or
3.
Participate in a program or activity to help me find and keep a job (for example: job search, job training,
career counseling, etc.), or
4.
Have a paid job and work at least 80 hours per month, or
5.
I am unable to do any of the above due to a verified medical condition, including mental health conditions.
___ I agree to work on completing the goals in my TILP, and to:
1.
Talk to my county case worker at least once a month to report on my progress and any problems I am
having in meeting the goals in my TILP.
2.
Tell my case worker as soon as possible, but no later than my monthly contact with my county case
worker, about any changes in how I am meeting one of the five eligibility conditions listed above.
3.
Tell my county case worker as soon as possible, but no later than my monthly contact with my case
worker, about any changes in my income (from work or any other source such as social security or
disability benefits, grants and scholarships).
4.
If I am in a county supervised placement such as a foster home, relative’s home, foster family agency
home, short-term residential therapeutic program (STRTP) or group home, transitional housing or a
supervised independent living placement:
I understand that the juvenile court will be supervising my case, and I agree to take part in six month
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Review Hearings, either in person or by telephone, or communicate my needs with my attorney; AND
I understand that if I don’t participate in my TILP that a court hearing may be set to possibly close my
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case. I understand that I will receive written notices of action (NOAs), and I can appeal these actions.
SOC 163 (7/17) (NO SUBSTITUTES PERMITTED)
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