Dss Form 30254 - Monthly Nytd Services Tracking Form - South Carolina Department Of Social Services Page 3

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Mentoring
Only includes a mentor relationship facilitated by the state agency or its staff.
Service Provided By:
Notes:
Supervised Independent Living
Occurs when a youth is living independently under a supervised arrangement that is paid for or provided by the state
agency.
Service Provided By:
Notes:
Education Financial Assistance
n
n
n
n
Textbooks
Computers
n
n
n
n
Educational Supplies
Fees
n
n
n
n
Tuition and Scholarship Assistance
School Travel
n
n
n
n
GED and Other Educational Tests
Personal Items
n
n
n
n
College Deposits
Child Care
n
n
n
n
Lab Equipment
Commuter Meals
n
n
Adult Education, Non-ETV Vocational and College Courses
n
n
Payment for Educational Preparations and Support Services
n
n
Other:
Service Provided By:
Other Financial Assistance
n
n
Interview and Work Clothing
n
n
Furniture
n
n
Senior Expenses (Pictures, Cap & Gown, Graduation Invitations)
n
n
Esteem Building Activities (Participating in Schools Sports, Music Programs, and ROTC)
n
n
Transportation Assistance (Commuter Allowances, Car Repairs)
n
n
Professional Attire for Youth No Longer in Placement Who are In School or Working
n
n
Dorm Showers, Apartment Showers, and “Pack-a-Sack” Program
n
n
Stipends Provided for Participation in Youth Groups, GOALL and SCNYTD Youth Voice
n
n
Other:
Service Provided By:
DSS Case Manager’s Name:
Telephone: (
)
County/Regional Office:
E-Mail:
Note:
NYTD Services must be entered into CAPSS under the “Support Services/NYTD” tab monthly as services are
provided.
DSS Form 30254 (JUL 16)
PAGE 3

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