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Foster and Kinship Care Education - Participation Registration Form

Foster and Kinship Care Participation Registration Form

California Community College

Foster and Kinship Care Education Program

 

The statical information will be used to keep accurate records of the services provided by the community college Foster and Kinship Care Education Program.  This information will assist the college in keeping accurate records of the classes you take.  It will also help the colleges to keep you informed of upcoming classes and events within the FKCE program at your local community college.  Your name, address, phone number, and partial social security number will remain confidential.  Statistical data (not personal information) may be reported to funding agencies.  No unauthorized personas will have access to your information.

 

 

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Question 1 of 8

 

Full Legal Name - First and Last and Middle

Question 2 of 8

Address:

City:

State:

Zip:

County:

Question 3 of 8

Phone - Please add cell and home - identifying each as cell or home

Preferred method of contact?

Question 4 of 8

E-mail Address:

Question 5 of 8

If you are an Approved Parent or Resource Family Applicant, check appropriate box:

A

Resource Family Applicant

B

Approved Resource Family

C

None of the Above

Question 6 of 8

If you are an NOT Approved Parent or Resource Family Applicant, check appropriate box:

A

Licensed Foster / Adoptive Parent

B

Informal Relative / Kinship Care Provider / Non-Relative Extended Family Member

C

County Social Service Staff

D

County Probation Staff

E

Foster Family Agency Staff

F

Short Term Residential Therapeutic Program Staff (Previously Group Homes)

G

Other: One who does not identify with categories listed

Question 7 of 8

If you would like to be notified of future FKCE classes offered at the college, please check a box.

A

Yes

B

No

Question 8 of 8

Please let me know if there are any specifs topics you would like to see as a training offered.  Please add as many topics as you would like:

Confirm and Submit