This application is for admittance into the Family and Community Development Specialist Training, a university based certification program. Applicants have the option of applying directly to the Intermediate FCD Specialist Training, with the fully completed application being scored based on your education and your experience. A non-refundable $25 application fee for the Intermediate training must accompany this application. Please carefully read the application and respond to the question/information to the best of your abilities. Once scored (30 points possible, 15 points minimum for enrollment), IACAA will advise you of placement within the certification training. Please note, if you are applying for the Introduction to FCD, you will skip some portions of this application. Please note, the Intermediate FCD Sessions must be successfully completed to attain the Specialist certification. If you have any questions or concerns, please contact Christine Westerlund at 217/789-0125 or at . Thank you and Good Luck!
Name:
Job Title and Program (for example: Family Development Specialist/ CSBG):
Current Caseload:______
Agency:
Address:
Phone:Fax:
E-mail: (this must be an operating, current address):
Education (list any college credits or degrees, plus relevant trainings):
______
Please Note: If applying for Intermediate FCD, you may be required to provide transcripts.
These two questions are for Intermediate FCD applicants only
Work Experience (most recent experience listed first, along with job title and number of years at locations or include your resume):
______
Brief Narrative (please write a paragraph on your interest and/or perceptions of the Certification training, including your understanding of the history and purpose of Community Action programs – you may use a separate sheet if needed):
______
Select which level of FCD Specialist Training that best fits your experience and interests:
Introduction – tuition - $700
Introduction to Community Action
Working with Low-Income Populations
Goal –Setting
Introduction to Outcomes
Interviewing
Intermediate – tuition - $875
Group Work
Assessment
Coaching and Mentoring
Diversity
ROMA and the Illinois Family Self-Sufficiency Scale
Self-Care/Professional Development
Advanced – tuition - $700
Motivational Interviewing
Advocacy and Community Development
Logic Models
Framework for Understanding Poverty
Families in Crisis
I attest this application is complete and an honest reflection of my background, education and experience.
______
Signature and date
Signature of Immediate Supervisor
Signature of Agency Director
2011 application