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

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.

Notice of Privacy & Practices Acknowledgement/Application for Supported Community Living Services - This is a combined form

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