Chinatown Family Economic Self Sufficiency Coalition

Last revised: 3/10/11

San Francisco Family Economic Success Workgroup

Family Economic Success Provider Certification Agreement

As a site interested in supporting San Francisco’s families to access critical economic supports, I agree to participate in the Family Economic Success (FES) Provider Certification Program including the following:

Pre-Certification Responsibilities

·  Staff from the site will successfully complete or test out of a series of 14 FES topic trainings

·  Staff from the site will complete an Enhanced Information and Referral training

·  A team of staff from the site including managers and direct service staff will participate in a training followed-up by a one-on-one consulting/coaching session on how to integrate FES into the site’s organizational culture

·  After participating in the 1:1 sessions, the site will develop an individualized FES Benefits Coverage Plan.

·  The site will register itself and each computer used for benefits screening and application with BenefitsSF.

Post Certification Responsibilities

·  Ensure that staff demonstrate competency on each of the FES training topics

·  Ensure that staff demonstrate competency on Enhanced Information and Referral

·  Ensure that managers and direct service staff will participate in a training followed-up by a one-on-one consulting/coaching session on how to integrate FES into their organizational culture

·  Complete, maintain, and annually update a FES Benefits Coverage Plan

·  Serve as a hub of FES resources for San Francisco families by providing enhanced referral or more on each of the FES benefits

·  Utilize BenefitsSF to assist families in accessing benefits

·  Share relevant information, resources, and expertise with other FES Certified Providers

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Executive Director Name Signature Date

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Organization Site

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Site Address

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Site Contact Person (Name/Title)

(______)______(______)______

Phone Number Fax Number

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Email Address Website

Please make a copy of this document for your records and mail or fax the original with the completed FES Readiness Assessment form to: San Francisco Family Support Network

1390 Market Street, Suite 900, San Francisco, CA 94102

Fax: (415) 554-8965

If you have any questions, please contact: Liz Cheng, SFFSN Training Coordinator

or (415) 934-4837