TAY Living Plan (PDF) - Independent Living Program

Youth Development Services
Los Angeles Department of Children and Family Services and Probation
Instructions To Youth: The purpose of this plan is to capture the goals you would like to achieve and the support
you need from your Transition (ILP) Coordinator over the next 6 months. This plan can help you stay focused and
organized as you progress toward accomplishing each goal. Your Transition (ILP) Coordinator will help you
achieve your goals.
TRANSITION AGE YOUTH LIVING PLAN (TAYLP)
Name Of Youth: State ID # (Staff Only) Social Security Number
XXX-XX-
Birth Date: Age: Sex: Ethnicity: Primary Spoken Language
English Other
Current Address: City: State: Zip Code:
Telephone #: E-mail Address: CAREGIVER’S NAME Marital Status:
I am a parent Parent Of # Expectant Parent N/A
School Attending/Last Attended: Grade: Passed the CAHSEE
Eng. Math
High School Graduation / GED Date:
IEP/Special Education Date:
Court Termination Date: (staff only):
Extended Foster Care?
SCHOOL/EDUCATIONAL/VOCATIONAL TRAINING PLAN
Currently, I am:
Attending high
school/GED Program
Name of school:
Attending college Name of college: ID #
Number of units completed:
Current grade point average:
Receiving financial aid, scholarships, and/or grant money
Educational Goals:
I plan to attend
Name of school:
I have applied for Financial Aid ( FAFSA) Yes No If No When:
I am currently attending a vocational Name of school:
training program at:
I need assistance with (specify):
EMPLOYMENT STATUS
Unemployed Employed Full-time Part-time Hours worked per
week:
Employer:
How long employed?
I do not have a job but, I am seeking employment/volunteer work.
Registered with a Work Source Center (WIA) Yes No
I am currently enrolled in:
Military service branch:
California Conservation Corps. Job Corps Americorps
I need assistance with (specify):

CURRENT HOUSING STATUS/HOUSING PLAN
My current living situation is:
Rent/own housing Share rent with others Stay in college dorm
Live with friends Live in board & care Live with relatives
Live in county or other Name of Program:
SILP
transitional housing.
Homeless Live w/care provider/guardian Live with parent(s)
Housing plan
I plan to live with:
I am interested in/ or need
assistance with:
Health Insurance Plan
What is your health insurance plan?
If you are not eligible for extended
Medi-Cal, where do you plan to get
health insurance from?
Continuing Support Services (i.e.
mental health, health services) Plan:
Family, Other Permanent
Connection, Mentor:
I plan to stay connected to family
and other adults (include names)
Resource phone numbers and websites:
ILP toll free number
1 (877) MY ILP 411
http://www.ilponline.org
Medi-Cal Health Insurance Benefits
application or to extend coverage
626-569-2968 or 626-569-2948
Youth Ombudsman
Office:
(213) 351-5720
Other Resources
Department of Public Social
Services
(DPSS)
1 (877) 597-4777
Edelman's Children's Court
(323) 526-6646
FINANCIAL RESOURCES
My sources of income include:
Work CalWORKs Cooperative for Assistance and
Relief Everywhere (CARE)
Department of Vocational EOP&S
Financial Aid/Scholarship
Rehab
General Relief Payments SSI/SSDI Temporary Assistance for Needy
Families (TANF)
Trust Account EFC (SILP) Other (Specify):
Revised 1/31/2013
Contact: Youth Development Services Division (ILP) Headquarters at (213) 351-0100
Toll Free Number: 1(877) MY ILP 411 or http://www.ilponline.org
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PERSONAL DOCUMENTATION
Do you have the following Have
important documents?
Birth Certificate
Financial Aid Award
Letter
High School Diploma Or
GED/School Records
Immigration Record/Green
Card/ Naturalization
Need
help
N/A
Do you have the
following important
documents?
Social Security
Card/Number
California Drivers
License/ID
Medi-Cal Card
Last two minute
orders from
Children’s Court
For Probation Youth Only
Have
Need
help
Juvenile Probation - Terminated Yes No
Youth on adult Probation Yes No
Need assistance with expunging my juvenile record Yes No
Need assistance with sealing my juvenile record Yes No
Need assistance with credit report or identity theft related issues Yes No
Other Specify):
Additional information if necessary:
_______________________________________________________________________________________
_______________________________________________________________________________________
Please note: Youth leaving the Kinship Guardian Assistance Payment (Kin-GAP) or Adoption Assistance
Payment (AAP) Programs receive Medi-Cal benefits through their next annual redetermination date, which
could be up to 11 months. Prior to the month of expiration, the youth will receive a redetermination packet
to be completed and returned for an eligibility evaluation to any other Medi-Cal benefits program. This is
why it’s important that we have your current address.
Please check with Transition (ILP) Coordinator for a complete list of required documents to receive ILP funds and to
verify eligibility. Youth might be eligible for ILP Services if he/she is or was a court dependent and placed in foster
care/probation placement at any time between the age of 16 and 18 or if under a Kin-GAP guardianship or if under a
non-related legal guardianship granted by Dependency Court after age 8 .
I understand that any requested funds are subject to availability and that failure to submit receipts
could jeopardize continued financial assistance from the ILP program.
Date your next TAYLP update is to be completed (six months): ________________
N/A
______________________________________________
Youth Signature
______________________________________________
Caregiver Signature (if applicable)
______________________________________________
Transition (ILP) Coordinator/Probation Officer Signature
_________________________________
Date
_________________________________
Date
_________________________________
Date
Revised 1/31/2013
Contact: Youth Development Services Division (ILP) Headquarters at (213) 351-0100
Toll Free Number: 1(877) MY ILP 411 or http://www.ilponline.org
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