1.   The State Agency (or agencies) that administers, supervises or oversees the programs carried out under the plan is identified. On page #:_____

   2.   The State Agency has indicated that it will cooperate in national evaluations of the effects of the programs implemented to achieve its purposes. On page #:_____

   3.   The State has described its program design, which includes goals, strategies, and an implementation plan for achieving the purposes of:

• Helping youth make the transition to self-sufficiency;
• Helping youth receive the education, training and services necessary to obtain employment;
• Helping youth prepare for and enter post-secondary training and educational institutions;
• Providing personal and emotional support to youth through mentors and the promotion of interactions with dedicated adults; and,
• Providing financial, housing, counseling, employment and other appropriate support and services to former foster care recipients between 18 and 21 years of age. On pages #:_____

   4.   The State has set a reasonable definition of "room and board&qupt; and provided the definition in the application. On page #:_____

         5.   The State has described how all political subdivisions are served by the program. On page #:_____

   6.   The State has identified and described how eligible youth are being served by the program to achieve independence. On page #:_____

   7.   The State has described how it involved the public and private sectors in helping adolescents in foster care achieve independence. On page #:_____

   8.   The State has described the objective criteria that was used for determining eligibility for benefits and services under the programs; and the process used for developing program criteria. On page #:_____

   9.   The State has provided a description of how it ensures fair and equitable treatment of benefit recipients. On page #:_____

       10.   The State has provided a description of who it consulted with in developing the plan, and the ways in which this was accomplished. On page #:_____

   11.    The State has provided a period of public comment which allows "all interested members of the public 30 days to submit comments on the plan" and submitted the results of public comment in the application. On page #:_____

   12.   Attachments A and B have been signed and dated by the State's Chief Executive Officer or delegate (if authorized by State law).

       13.   The State has identified the amount of Federal funds for which it is applying. On page #:_____