CFS 574
Rev 3/2011
State of Illinois
Department of Children and Family Services
Office of Training and Professional Development
FOSTER PARENT TRAINING CREDIT APPROVAL FORM
PLEASE PRINT. Keep the original for your records. Fax or Mail a copy to: DCFS Office of Training, 406 E. Monroe, Station
122, Springfield, IL 62701, FAX 217-782-9301 within 30 days following completion of training
. Requests submitted 6 months or
more after the training will not be approved
. Unreadable or incomplete Training Credit Approval Forms will be returned. One
form is required for EACH person
and EACH training event.
1. PARENT INFORMATION – CHECK ONE: Non-Related Foster Parent Relative Foster Parent
Other
Last Four Numbers of Your Social Security Number -
Name: (First)
(Last)
Please Print Please Print
Address:
City: State: Illinois Zip: County:
Area Code & Home Phone #: Cell Phone #:
Do you have access to a computer? Yes No Do you have internet access? Yes No
E-Mail Address:
2. LICENSING INFORMATION - Call your agency office for this information if you do not know it.
Foster Care License Number: Expiration Date:
Family Development Specialist / Licensing Worker Name:
Agency Name: Worker Email:
Agency Address: Phone: ( )
City: State: Illinois Zip:
3. TYPE OF TRAINING – check ONE box (Please send supporting documents, noted on back of form)
A. Classroom Training Course On-Line Training Course
Name or Title of Classroom Course/On-Line Course
Training Location/Agency Name/Internet Address
B. Videotape / Audiotape/ DVD Run Time: Hours Minutes
Title: From DCFS Lending Library? Yes No
C. Book Number of Pages Author
Title: From DCFS Lending Library? Yes No
Attach a copy of the table of contents from the book you read if the book is not from the DCFS Lending Library.
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