Healthy Families Indiana CORE Training Registration Form

  
     
 Telephone: 800-752-7116
 Fax Number: 260-421-5003  

Each Person Must be Registered Individually

 

  
 Name: County:
 Agency: Cell Phone:
 Date of Hire: E-mail address:


 Is this your first HFI Core Training? Yes    No             If no, date of first HFI Core:    

 Are you attending this CORE in order to be cross-trained?    Yes    No   
  "If so, you are only required to attend day 2, 3 and 4 of this CORE training.”   

 Current position:             FSS/FSW
                                     FRS/FAW
                                     Supervisor
                                             Managers    
                                       Other       

 I want to register for:    FSS/FSW
                                      FRS/FAW
                                     FSS/FSW
                                    Supervisor          

 Contact's emergency phone number (daytime):                            
                                                     (evening):       

     
 ____________________________________________________________________________________________
                                                           TRAINING CHOICE

 Date/Location of training:
                                                      

 

“BEFORE ATTENDING CORE TRAININGS, ALL TRAINEES WILL SUBMIT PROOF TO THE HFI ADMINISTRATIVE ASSISTANT THAT THEY HAVE SHADOWED 3 HOME VISITS, 3 ASSESSMENTS, AND HAVE READ 5 HOME VISIT REPORTS.”

 

PROOF OF SHADOWS OF HOME VISITS

 

CLIENT NUMBER AND HVR NUMBER (S) AND DATE:

1

2

3

 

ASSESSMENT NUMBER WITH DATE OF ASSESSMENT:

1

2

3

 

CLIENT NUMBER, HVR NUMBER AND DATE OF HOME VISIT REPORTS READ:

1

2

3

4

5

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