DCFS Youth Recovery Assistance Checklist (RAC) Instructions
This form contains 23 fields organized into 7 sections. Below is a complete list of every field, its type, and what information is expected.
| Field Name | Type | Description |
|---|---|---|
| 1. The youth meets the required RAC criteria: | ||
| Youth meets age out criteria | Checkbox |
Check this box if the youth was formerly in care and aged out after April 1, 2020, or will age out on or before September 30, 2021.
|
| Youth submitted photo ID | Checkbox |
Check this box if the youth has submitted a copy of photo identification (driver's license, state identification card, school, or employment identification).
|
| Applicant and Case Information | ||
| Applicant Name | Text |
Enter the full name of the applicant, including last name, first name, and middle initial.
|
| Date of Birth | Date |
Enter the applicant's date of birth.
|
| Age | Text |
Enter the applicant's current age. Fill only if 'Date of Birth' is a valid date, from which age can be calculated.
Depends on:
Date of Birth
|
| DCFS Case Closure Date | Date |
Enter the date when the DCFS case was closed.
|
| CYCIS ID Number | Text |
Enter the CYCIS identification number.
|
| Contact Information | ||
| Email Address | Text |
Provide the email address for contact.
|
| Telephone Number | Text |
Provide the telephone number for contact.
|
| Social Security Number | Text |
Provide the Social Security Number.
|
| Mailing Address | ||
| Mailing Street Address | Text |
Provide the street address for the mailing address.
|
| Mailing City | Text |
Provide the city for the mailing address.
|
| Mailing State | Text |
Provide the state for the mailing address.
|
| Mailing Zip Code | Text |
Provide the zip code for the mailing address.
|
| Virtual RAC Meeting Date | ||
| Virtual RAC Meeting Date with C21 Staff | Checkbox |
Check this box if a Virtual RAC Meeting Date with C21 Staff has occurred for a youth who is over 21 with a closed case. Fill only if 'Youth is over 21 with closed case' is 'Yes'.
Depends on:
Youth is over 21 with closed case
|
| Meeting Date Month | Text |
Please provide the month of the virtual RAC meeting. Fill only if 'Virtual RAC Meeting Date with C21 Staff' is 'Yes'.
Depends on:
Virtual RAC Meeting Date with C21 Staff
|
| Meeting Date Day | Text |
Please provide the day of the virtual RAC meeting. Fill only if 'Virtual RAC Meeting Date with C21 Staff' is 'Yes'.
Depends on:
Virtual RAC Meeting Date with C21 Staff
|
| Meeting Date Year | Text |
Please provide the year of the virtual RAC meeting. Fill only if 'Virtual RAC Meeting Date with C21 Staff' is 'Yes'.
Depends on:
Virtual RAC Meeting Date with C21 Staff
|
| Youth Exiting Care Authorization | ||
| Checkbox15 | CheckBox | |
| Authorization Month | Date |
Provide the month the youth met with the worker to review RAC requirements and responsibilities. Fill only if 'Checkbox15' is 'Yes'.
Depends on:
Checkbox15
|
| Authorization Day | Date |
Provide the day the youth met with the worker to review RAC requirements and responsibilities. Fill only if 'Checkbox15' is 'Yes'.
Depends on:
Checkbox15
|
| Authorization Year | Date |
Provide the year the youth met with the worker to review RAC requirements and responsibilities. Fill only if 'Checkbox15' is 'Yes'.
Depends on:
Checkbox15
|
| Youth Over 21 Condition | ||
| Youth is over 21 with closed case | Checkbox |
Check this box if the youth is over 21 years old and their case is closed.
|