DCBS Training Branch Request for Training Credit Approval

(Submit 30 days prior to event including documentation)

RTC Name/Region or Central Office Department:

Requestor’s Name/Position:

Email Address of the Requestor:

Please check all that apply (double click on the shaded box and mark checked in the pop-up):

Request training to be provided:

Request training to be developed:

Request consultation/assessment of training materials:

Please describe the program content area/audience/# of participants/attach agenda; if applicable.

Family Support (generic)	Supervisors	#participants

Family Support (Adult Medical)	Central Office	# participants

Family Support (KHBE)	Front Line Staff	# participants

Family Support (SNAP)	Secretarial/Support	# participants

Family Support (KTAP)	Foster/Adoptive Parent(s)	# participants

P & P (APS)

P & P (CPS)	Other: (please specify)	# participants

P & P (Intake Only)

P & P (R & C Staff)

Foster/Adoptive Parent(s)

Other (please specify)

Training Title:

Training Date:

Training Site:

Name of Trainer:

Hours of Completion:

Upon completion of this training, participants will be able to meet the following performance objectives:

Is there a mandatory completion date for the training? If so, list.

Proposed Delivery Method (double click on the shaded box and mark checked in the pop-up):

Web based	Face to Face	Polycom/Teleconference

Webinar	Combination	Other: (please specify)

Date request is being sent:

Email this request to dcbstris@ky.gov. You will be contacted within five working days about the request.

Section Below for Use by Approving Authorities

Approved as submitted by:	Date:

Approved with changes by:	Date:

Denied by:	Reason:	Date: