CFS 912, Referral Form for Life Skills/Financial Literacy Education Completed Form Examples and Samples

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A screenshot showing the automated data extraction and filling of the CFS 912 Referral Form for DCFS life skills services.

Source document used: Caseworker Case Narrative Memo

Subject: Referral for Marcus Thorne - Life Skills Program

Date: May 12, 2026

I am writing to initiate the referral for Marcus Thorne, DOB 09/14/2007 (Age 18), for the Life Skills program. Marcus is currently residing at 442 Oak Street, Chicago, IL 60614, in Cook County. He can be reached via email at [email protected], his home phone is 312-555-0198, and his cell is 312-555-0921. For emergency contacts, please reach out to his foster parent, Sarah Miller, at 882 Pine Avenue, Chicago, IL 60614, phone 312-555-4433.

Regarding documentation, I have attached the full packet: the completed CFS 912, the current SACWIS service plan face sheet, his Integrated Assessment, the scored Casey Life Skills Assessment, and a signed CFS 600-3. Marcus does not have any physical disabilities, but he identifies as a visual learner. He is generally available for afternoon sessions on Tuesdays and Thursdays after 3:00 PM. 

I am the assigned worker, James P. Henderson (R/S/F: 4421-B), located at the DCFS District 1 Office, 123 Main St, Chicago, IL 60601. You can contact me at 312-555-7788 or by fax at 312-555-7799; my supervisor is Linda Garcia (312-555-2244). My email is [email protected]. Marcus has been doing well, though he occasionally struggles with anxiety. There are no immediate safety-related concerns. For transportation, he utilizes the CTA bus system and will require a monthly transit pass provided through our office budget to attend classes. His DCFS ID is 9988776655.