Children’s Division Resource Family In-Service Training Request
- Each individual must complete a separate training request form - Only one training request per form - CD staff will return signed form to the resource provider after approval signatures are obtained - The resource provider completes the Section C describing what was learned and submits it to the worker
Section A
Name	County / Circuit /	Vendor #
Type of Training (indicate below):
Group / Conference Training
Title of Training:
Training Content Information attached: Training Syllabus Brochure Other
Training Verification attached: Signed Certificate Letter of Completion Other
Date(S) and Time(S) of Training	Location Where Attended
Training Instructor(S)	Number of Actual Hours In Training. (Time Required for Travel and Meals Will Not Be Included.)
Self-Trainings / Special Trainings	Indicate Type:
Book	Title	Author	No. of Pages
Video	Title	Length (time)
Web-based	Title	Length of training	Web Address Certificate of completion attached
*There is no reimbursement available for expenses incurred for non-agency trainings, including book, video, or website trainings. Mileage and baby sitting reimbursements may not be approved by the Supervisor without prior approval for the training.
Section B
This section is to be completed by Agency Staff. Prior approval not required, however, All signatures indicated are required for training credit to be applied and any monetary reimbursement approval.
Will this area of training assist the provider in meeting their Professional Family Development Plan goals? Yes No
Training hours requested:	This provider has met his/her PFDP goals? Yes No
Training credit code:
Approved	Yes No
CSW	Date
Approved	Yes No	hours
CSW Supervisor	Date
Section C
Describe what you learned from this training; include any new parenting skills that you plan to use in your home or with a specific child. (Attach additional sheets as needed. Each individual must submit a form, including this section.)