Youth SCL Referral Packet

Our site is under construction, so please excuse the mess

This packet is for youth placement only. Please contact your respective regional office for approval and any addition requirements prior to placement.

Application for Supported Community Living Services/Notice of Privacy Practices

Supported Community Living Training

Referral & Placement of Child/Youth to Out of Home Care Checklist - Include copy of completed checklist with required placement packet paperwork sent to the Regional SCL Office.

Community Placement Application Form for Minors (DMH 8311) - This form is kept in the Administrative Agent Clinical Record and a copy sent to the facility along with the other requirements for the Administrative Agent Referral Packet.

Consent and Agreement for Supported Community Living Services: Children and Youth (DMH 9716)

Standard Means Financial Questionnaire (DMH 69)/Notice of Cost (DMH 8004) - This is a combined form

Notice of Change/Status Form

JSOR General Notification Letter to the Parent or Guardian