Discharge
DROP by visits are not allowed. Hey FRannDs are invited to the safe homes for the purpose of scheduled community building and programming as appropriate and residential staff approval is required. Guests may not accompany Hey FRannD for residents.
Sign in to Google to save your progress. Learn more
Email *
Has the residents' probation officer been notified? *
Discharge plan: Upon discharge, it is recommended that (indicate any referrals made upon discharge) *
Reason for leaving
check one
Graduated program
More Intensive services needed
Program Infraction
Relapse
Resident choice
Resident choice conflict with housemates
Resident choice program restrictions
Resident choice relationship with family/friend/significant other
Eligibility for readmission *
Name *
Discharge date *
MM
/
DD
/
YYYY
Housing
check one
Left for permanent housing
Left to live with family/friends
Went to jail
Transfered to another program
Deceased
Unknown
The resident was discharged with the following:
Is the resident willing to be contacted to assess progress after discharge? *
The resident acknowledges that all personal belongings brought to DDF and purchased by her during the residency with being returned to her (not her representative by DDF staff. Residents must take their belongings upon discharge. We do not hold items for residents at discharge unless scheduled with the Director of Programs. The resident acknowledges that she has left her room and in clean good condition. Resident acknowledges that she has not removed items routinely used that belong to DDF such as hair dryers, alarm clocks, and pots/pans, etc.) The resident acknowledged that she must refrain from sharing the location of the residence. The resident will change their mailing address with all business, healthcare, providers, and financial institutions and DDF is not responsible for any mail or packages upon discharge.  
Graduates: Graduates understand you will always be a HEY FRannnD for life, however, access to DDF residential will no longer have access to the DDF residence at will. The graduate agrees to respect the privacy of residents living in the home and will never enter the residence without pre-arranged permission from DDF or the current resident that the graduate is visiting. Graduates will be invited to take part in the DDF community Christmas party, as well as DDF graduation ceremonies. All other events are designated for current residents. Graduates are encouraged to complete the graduate volunteer program if she desires to serve in the community as a mentor or transportation volunteer.
Graduate
Resident acknowledgment *
Required
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of differentdayfoundation.org. Report Abuse