APPLICATION FOR SERVICES THROUGH THE LUCAS NELSON RESOURCE CENTER NAME____________________________________ ADDRESS______________________________________________________________________________________ DATE OF BIRTH_________________________ EMPLOYER/ADDRESS___________________________________________________________________________ DO YOU HAVE AN ACTIVE CASE WITH DCS (DEPARTMENT OF CHILDREN'S SERVICES)?____________ IF YOU ANSWERED YES, PLEASE GIVE A BRIEF DESCRIPTION OF YOUR CASE BELOW:_____________ IF YOU ANSWERED NO, ARE YOU IN DANGER OF INVOLVEMENT WITH DCS?________________________ WHY?____________________________________________________________________________________________ DCS CASEWORKER NAME AND PHONE NUMBER_____________________________________________________ ATTORNEY/PUBLIC DEFENDER NAME AND PHONE NUMBER________________________________________ DO YOU HAVE CUSTODY OF YOUR CHILDREN?_____________________________________________________ IF NOT, WHERE ARE THEY NOW?_________________________________________________________________ NEXT COURT DATE______________________________________________________________________________ HAVE YOU BEEN GIVEN A PERMANENCY PLAN ( A PLAN GIVEN BY THE COURT OR DCS)? ____________ WHAT THINGS HAVE YOU ALREADY COMPLETED ( EXAMPLE PARENTING CLASS, ETC.)?______________ _________________________________________________________________________________________________ WHAT IS YOUR GOAL IN COMPLETING SERVICES AT LNRC?_______________________________________ _________________________________________________________________________________________________ WHAT WOULD BE YOUR PREFERRED OUTCOME IN YOUR COURT CASE?_______________________________ __________________________________________________________________________________________________ HOW DID YOU HEAR ABOUT THE LUCAS NELSON RESOURCE CENTER?________________________________ *PLEASE FILL OUT ALL QUESTIONS. IF SOMETHING DOESN'T APPLY TO YOU PLEASE MARK N/A. *YOU MAY BE ASKED TO PROVIDE ALL NECESSARY PAPERWORK PERTAINING TO YOUR CASE, IF YOU NEED ASSISTANCE GETTING THESE THINGS PLEASE LET YOUR CLIENT ADVOCATE KNOW. *WE DO **NOT** PROVIDE ANY SORT OF LEGAL ADVICE. YOU WILL NEED TO SPEAK WITH AN ATTORNEY.