Jones Pathways for Youth – Case Manager Transition & Documentation Form
Complete this form to document the youth’s transition needs and available documentation for housing intake scheduling.
Purpose of This Form & Pre-Placement Requirements
This form documents the youth’s identity, communication access, funding and payment arrangements, essential resources, and case management transition plan so Jones Pathways for Youth can coordinate a safe, supported independent-living placement. Completing or submitting this form does not guarantee acceptance, reserve a bed, or confirm a move-in date. A move-in date will NOT be scheduled until the youth has (1) a working personal phone with a sustainable service plan, (2) an accessible personal email address, (3) valid, unexpired government-issued photo identification, (4) a confirmed, actionable transition plan identifying the assigned case manager, support responsibilities, education/employment and transportation arrangements, food/personal essentials, and next steps, and (5) verified housing funding with a confirmed payment arrangement. Housing payment is due on or before move-in; any payment within seven calendar days after placement requires advance approval. If funds will not be accessible in time, the referring case manager/agency must proactively pursue alternative funding/grants through Porter Center, Catholic Charities or other appropriate assistance providers; assistance is not guaranteed. The youth must be aware of the referral and able to participate in intake, and required onboarding documentation must be reviewed before move-in is confirmed. Referring case managers must provide accurate information, disclose pending items and deadlines, and remain responsible for arranging resources and coordinating the transition; Jones Pathways for Youth provides housing but does not guarantee funding, groceries, phone service or ongoing case management.
I have reviewed the pre-placement requirements and understand that a move-in date cannot be scheduled until they are satisfied.
*
I have reviewed the pre-placement requirements and understand that a move-in date cannot be scheduled until they are satisfied.
Youth Identification
Use this section for the youth’s details only. If you are completing the form on the youth’s behalf, enter the youth’s information here.
Youth Full Name
*
First Name
Middle Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Current Placement Name
*
Application Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Referring Case Manager
Use this section for the case manager or agency contact completing or supporting the referral.
Case Manager Name
*
First Name
Middle Name
Last Name
Agency
*
Work Email
*
example@example.com
Work Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Application Participation
These questions confirm how the form was completed and whether the youth can participate directly.
How was the inquiry completed?
*
Completed personally by the youth
Completed with assistance
Completed by the case manager on the youth's behalf
Is the youth aware of this referral?
*
Yes
No
Unsure
Intake Availability
Use this section to note whether the youth can speak with intake now and what timing limits apply.
Can the youth participate directly with intake now?
*
Yes
No, not until leaving current placement
Needs scheduling
Earliest date/time the youth can be contacted or scheduled
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Safe contact arrangement
*
Independent Communication
Use this section for the youth’s own communication details and any support needed for direct contact.
Does the youth have a working personal phone?
*
Yes
No
In Progress
Personal phone number
Please enter a valid phone number.
Format: (000) 000-0000.
Is the agency helping obtain a phone?
*
Yes
No
In Progress
Does the youth have an accessible personal email?
*
Yes
No
In Progress
Personal email address
Youth’s personal email, not agency email.
Who will assist and expected date
Identification
Use this section for identity documents and whether support is needed to obtain them.
Does the youth currently have a valid, unexpired state-issued photo ID or driver's license?
*
Yes
No
In Progress
Is the case manager or agency assisting the youth in obtaining ID?
*
Yes
No
Anticipated date ID will be available
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Income and Housing Funding
Use this section for income sources, funding support, and any documents that verify the information.
Housing Payment Deadline & Funding Gap Requirements
Jones Pathways for Youth requires housing payment on or before move-in. Payment within seven (7) calendar days after placement is permitted only when an exception has been approved in advance. If the youth's funds will not be available by the approved deadline, the referring case manager/agency is responsible for proactively seeking alternative funding or grant assistance before placement, including potential resources such as the Porter Center, Catholic Charities, or other appropriate community assistance programs. Funding from these resources is not guaranteed. The case manager must communicate the funding source, anticipated availability date, referral status, and a proposed payment arrangement to Jones Housing Programs before move-in can be confirmed.
Jones Pathways for Youth requires housing payment on or before move-in. Payment within seven (7) calendar days after placement is permitted only when an exception has been approved in advance. If the youth's funds will not be available by the approved deadline, the referring case manager/agency is responsible for proactively seeking alternative funding or grant assistance before placement, including potential resources such as the Porter Center, Catholic Charities, or other appropriate community assistance programs. Funding from these resources is not guaranteed. The case manager must communicate the funding source, anticipated availability date, referral status, and a proposed payment arrangement to Jones Housing Programs before move-in can be confirmed.
Acknowledgment
*
I confirm I have read and understand this payment and funding-gap policy.
Current Verifiable Income Source(s)
*
Extended Foster Care
Agency Funding
ASSIST funding
Sponsor/Support Person
Employment Income
Benefits/Assistance
Other
Other
Monthly Amount
*
Funding Status
*
Please Select
Confirmed
Pending
Not Available
Responsible Payer
*
Agency Contact
First Name
Middle Name
Last Name
Documentation Uploads
Upload only the documents that are actually available. Do not upload irrelevant or fabricated files.
Is income or benefits verification available?
*
Upload income or benefit verification
Upload a File
Drag and drop files here
Choose a file
Upload only if available.
Cancel
of
Is funding authorization or commitment available?
*
Upload funding authorization or commitment
Upload a File
Drag and drop files here
Choose a file
Upload only if available.
Cancel
of
Is transition paperwork available?
*
Upload transition paperwork
Upload a File
Drag and drop files here
Choose a file
Upload only if available.
Cancel
of
Youth Readiness and Case Manager Action Plan
Use this section to capture next steps, action owners, and due dates after intake review.
Outstanding tasks or next steps
*
Who is responsible for each task?
*
Target date for completion
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Acknowledgement
Use this section to confirm understanding of the form’s purpose and any required follow-up.
Acknowledgements
*
I confirm the youth must participate directly in intake and maintain reliable independent communication for onboarding
I understand identity verification is required before onboarding
I understand this form does not guarantee placement
I understand this is not an emergency shelter referral
Acknowledge and confirm
*
Please review the form carefully before submitting. Only include accurate information and upload documents that are actually available.
Urgent & Emergency Placement Requests
Urgent referrals can receive priority review, but they still must meet all standard requirements before a move-in date is confirmed.
Jones Pathways for Youth understands that referrals may be urgent due to foster-care exits, discharge deadlines, homelessness, or other circumstances. Urgent referrals can receive priority review, but urgency never waives screening, documentation, identification, working phone and accessible email, basic essentials, verified funding/payment arrangements, transition planning, onboarding, or approval requirements. Every placement must complete the standard process and be approved before a move-in date is confirmed. Proposed dates are not confirmed dates. Referring case managers must complete their responsibilities promptly and provide accurate information; Jones Pathways for Youth will respond and coordinate promptly when requirements are satisfied.
I understand and agree to the urgent placement requirements above.
*
I understand and agree.
Submit
Submit
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