Form Ad 4320l - Adoption Assistance Program (Aap) Agreement Page 9
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9STATE OF CALIFORNIA – HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
SECTION II (Deferred Agreement)
I/We understand that ______________________________________is AAP eligible and
(Name Of Child)
although assistance is not needed at this time, I/we understand that at anytime, I/we
may request AAP benefits.
SECTION III SIGNATURE
Adoptive Parent:
Date:
Date:
Adoptive Parent:
Date:
Child’s Agency Representative:
Child’s Agency Name:
Date:
Family’s Agency Representative (Co-Op Placement Only):
Family’s Agency Name:
AD 4320L (1/17)
PAGE 9 OF 9
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