STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CWS/CMS CASE MANAGEMENT
90-DAY TRANSITION PLAN
This form is for you to develop a plan when you are within 90 days of leaving foster care. This plan will
focus on activities that you will complete during this time. This is as an agreement between you and
those supporting you to work toward completing your transition plan. This should be developed with you
in a transition conference setting, or group meeting, with those you want involved and who are helping
you to successfully transition out of foster care.
Instructions To Youth: During the 90-day period before you leave foster care, you will make a
transition plan that shows where you plan to live, receive additional support, work and/or go to school
after you leave care and help keep family connections. The purpose of this plan is to help you take
steps to successfully live on your own.
Instructions to Caregiver/other adults: If asked by the youth, you are also agreeing to assist the
youth in the development of a 90-day transition plan that will help him/her to successfully transition
out of foster care.
Instructions to Social Worker/Probation Officer: During the 90-day period prior to the youth
exiting foster care, you are agreeing to assist the youth in developing a transition plan that will
address his/her needs for housing, employment, education, mentors, continuing support services
and health insurance.
Instructions for Family, Service Providers, CASA and others connected to and supporting
the youth: If asked by the youth, you are also agreeing to assist the youth in the development of a
90-day transition plan that will help him/her to successfully transition out of foster care.
During the 90-day period prior to aging out of care:
This plan is to be completed within the 90 day period before you turn 18, or exit foster care after age
18. If you emancipate from care before age 18, this plan should be completed within 90 days
before your target emancipation date.
The sections on the next page must be completed to include your plan for education, employment,
housing, mentoring, family connections, continuing support services and health insurance. The plan
must be personal to you and as detailed as you can get. The plan must contain specific actions that
you and others will take to help you prepare for leaving care.
*Note: The last page of this form has an example grid that can give you ideas to help make your
planning very concrete.
Copies to: Youth - Caregiver - Case File - ILP - Family - Others
FC 1637 (5/14) PAGE 1 OF 4
YOUTH: DOB:
AGE:
ETHNICITY:
CASE WORKER NAME: CASE WORKER PHONE:
90-DAY TRANSITION PLAN
Additional boxes can be inserted if needed
Education Plan:
To prepare, I or a supporting
adult (name) will:
Recommended documents
the youth will need
Employment Plan:
To prepare, I or a supporting
adult (name) will:
Recommended documents
the youth will need
Housing Plan:
To prepare, I or a supporting
adult (name) will:
Recommended documents
the youth will need
Mentoring & Continuing Support Services (e.g.
mental health, health services) Plan:
To prepare, I or a supporting
adult (name) will:
Recommended documents
the youth will need
Family and Other Permanent Connections:
I plan to stay connected to
family and other adults by:
Recommended documents
the youth will need
Health Insurance Plan:
If not eligible for extended
Medi-Cal, I plan to get
health insurance through:
Agency, employer or other
person providing
health insurance:
Copies to: Youth - Caregiver - Case File - ILP - Family - Others
FC 1637 (5/14) PAGE 2 OF 4
ACKNOWLEDGEMENTS:
I know that I must sign verification paperwork to continue my Medi-Cal health insurance benefits when
I exit from foster care and again each year to receive Medi-Cal until my 26th birthday or until I have
secured a different type of health insurance. I am also aware that when I move I must resubmit a
verification form with my new address. ______ youth’s initials
I have been told that when I am 18, I can choose a “power of attorney for health care” that can make
medical choices for me if I am not able. When I turn 18, I will receive directions and a form that I can fill
out if I want to choose a power of attorney for health care. ______ youth’s initials
I know that 30 days prior to leaving foster care, I am eligible to apply for food stamps. _____ youth’s
initials
I agree to meet with my caregiver and social worker/probation officer as needed to ensure sufficient
progress towards my goals.
Target date for exiting foster care ______________
By signing below, this means we will all work to complete the steps necessary to help the youth
complete his/her transition plan.
Youth’s signature Date
Caregiver’s signature Date
Social Worker/Probation Officer signature Date
Family Member signature Date
Service Providers/Therapist signature Date
CASA/Other Youth Advocates signature Date
LEGISLATIVE & REGULATORY REFERENCES:
Public Law (P.L.) 110-351, which states that a Transition Plan must be developed at the
direction of the youth during the 90 day period prior to the youth aging out. The plan
must contain specific options on housing, health insurance, education, local
opportunities for mentors/continuing support services and workforce
support/employment services. P.L. 111-148 requires providing foster youth with the
information about a Power of Attorney for Health Care.
Copies to: Youth - Caregiver - Case File - ILP - Family - Others
FC 1637 (5/14)
PAGE 3 OF 4
90-DAY TRANSITION PLAN EXAMPLES
Education Goals:
I plan to attend….
TimeLine
FAFSA due: 01/01/2009
School application 01/15/2009
Scholarship app: 02/01/2009
Housing app: 03/01/2009
(Due dates of all document and
application deadlines)
Recommended documents the
youth will need
Copy of School application
Copy of FAFSA application
Copy of Chafee grant
application
Copy of Guardian Scholar
application
Copy of High School
transcripts
Employment Plan:
I have Prepared by: Recommended documents the
youth will need
I plan to get/have a job at….
Completing ILP Proficiency
Certificate checklist
Copy of resume
Copy of Permanent Resi-
1.
Completing job applications
dency card (if applicable)
2.
at:_________
Having Social Security card
List of people willing to
provide reference
3.
available
4.
Identifying people to
provide reference
Housing Plan:
I have prepared by:
Recommended documents the
youth will need
I plan to live with/in...
Touring the facilities
Copy of housing application
Confirming deposit and
Housing deposit verification
move-in arrangements
Completed cost of living
Checking resources pro-
budget
vided by housing facility
Family Connections:
I plan to stay connected to family
and other adults by:
Recommended documents the
youth will need
I feel closely connected to ...
Having phone and in-person
contact with…..
Making a plan to stay with
….during college dorm
breaks
Having email addresses
for…
Contact list for family
members
Copies to: Youth - Caregiver - Case File - ILP - Family - Others
FC 1637 (5/14)
PAGE 4 OF 4