-a-tnoOV ** ^V O f H , REOBVEDiN -4 V Ct <\ np^XffC"WNWL/#P6flU APR 114 2015
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:&a!j^ - K\c^AaA.^q_o cicoA. ^ rL^QA^i^Ld_. ^(^_SQ^7orvQ ..AZlP(^.5£ JUiLl^4^ £j(^.L OiaxWi y^as. \acX o£ l: -Cmx\A- ^ju^ _^^^SMs_a.L ^->n \o^:U-.^X^.Q9. tC^£LS^^Osr\Lx^£i^ KlOA Aml..J^^ J £^XO/^^ x____: 2>:5U 7' ^xas Dept of Family -B000 and Protective Services January 2009 CHILD SAFETY EVALUATION AND PLAN Plan for Immediate and Short-Term Child Safety
Page of Family Name
TASKS AND SERVIOES-List lOEi all tasks and services needed to provide for the child's immediate and short-term safety.
Family Task CPS/Other Service
C/S ^U£/4A^^C&n 4tMlTq*k x^A^y "ty^f*1 Beginning and Eodirig Dates/and/orfrequency) /^ / Begnnafnaagd Ending Datea(arfd/or **H*n Fpeduency). to 5l?aJJ>/o ^fyum<. of Evaluatjpn Method of Evaluation ( J^p i r_i
Conclusion-Identify plans for further services. When appropriate, describe the possible consequences if the family does not carry out this plan successfully. If the case is to be closed, jccessfully. Ifthe closed, explay explain why. why. , * J I
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Signatures-By signing this form, the parents are agreeing to perform the tasks specified in this plan, and applying for Title IV-Aemergency assistance to help cover the cost of CPS's services. Note: To function as an application for Title IV-A emergency assistance, this form must be signed by at least one parent or relative of the child.
Parents also agree that this plan does not conflict with any existing court order.
The parents may request a review ofthis plan at any time. They may also request an administrative reviewer a fair hearing ifCPS denies, reduces, or terminates any protective se^ices oremergency, assistance that they have requested<