Missouri Department of Social Services

Children’s Division

Family-Centered Services Trainer Confirmation

Trainer Information
Name:
Address:
City, St Zip
Phone #:	E-Mail Address:

1.	The Trainer listed above agrees to provide staff development training for the Children’s Division as follows:

Date(s) of Training :
Location of Training:
Title of Training/Training Topic:
Requesting Children’s Division Office:

2.	The Trainer agrees to assist the Children's Division (CD) in developing the content of the training in accordance with Children’s Division’s identified goal(s) for the training.

3.	The Trainer agrees to develop the curriculum, evaluation and applicable materials for the training in collaboration with designated Children’s Division staff and agrees that any curriculum and all applicable materials utilized for the training will be subject to the final approval of the Children’s Division.

4.	The Trainer agrees to present all aspects of the training in such a manner that allows maximum application in the workplace for training participants.

5.	The Trainer agrees to the fee schedule listed below for services provided. The Trainer acknowledges and agrees that the applicable rate paid to the Trainer under the fee schedule shall be inclusive and no other payments or reimbursements shall be made to the Trainer.

Bachelor’s Level Trainer:	$50.00 per thirty minute unit
Master’s Level Trainer:	$75.00 per thirty minute unit
Doctorate of Medicine (MD) Trainer:	$150.00 per thirty minute unit
Juris Doctorate (JD) Level Trainer:	$150.00 per thirty minute unit
Negotiated Price:	per thirty minute unit
Maximum # of Units/maximum Price for this Training:

6.	By no later than the fifth (5th) day of the month following the training, the Trainer agrees to submit an itemized invoice, evaluation forms, and sign-in sheets for the training to the requesting Children's Division office identified above.

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The undersigned hereby agrees to provide the training services listed herein, at the prices stated.

Signature for the Trainer	Date