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REQUEST FOR ADOPTION ASSISTANCE PROGRAM BENEFIT

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCYCALIFORNIA DEPARTMENT OF SOCIAL SERVICESREQUEST FOR ADOPTION ASSISTANCE PROGRAM BENEFITThe ADOPTION ASSISTANCE PROGRAM (AAP) provides benefits to adoptive parents to enable them to meet the needs of AAP-eligible children who are available for ADOPTION . The AAP BENEFIT is a negotiated amount based on the needs of thechild and the circumstances of the family determined through discussion between the responsible public agency and theadoptive parents.

3. MONTHLY AAP BENEFIT REQUESTED, IF ANY Check ( ) the box that corresponds to the benefit you are requesting: For Basic Care (Food, Clothing, Shelter, etc.) For care and supervision based on the child’s special needs. Medi-Cal Only. Please provide a description of your child’s special needs and the required extra care and supervision that would qualify

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