Training for Adoption Competency Student Application

This is the student application for the Training for Adoption Competency (TAC).

Date*
Date Format: MM slash DD slash YYYY
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Business Phone*
Mobile Phone
Email*
Education
Undergraduate Education*
College/ University Major Degree Year of Degree
Graduate Education*
College/ University Major Degree Year of Degree
Licensure Information
Type of License
State of Licensure
License Number
Date through which license is current
Date Format: MM slash DD slash YYYY
Clinical Experience
Date (list most recent first) Agency or Private Practice Setting (name, address) Supervisor Nature of Practice
Personal Statement*
Please provide a personal statement that addresses: 1. Why you are interested in enrolling in the TAC program 2. Your clinical background, including your areas of clinical specialization, and how your clinical background prepares you to develop more advanced adoption competent knowledge and skills 3. Your interest(s) in working with members of the adoption kinship network (adopted persons, prospective adoptive parents, birth parents and birth family members, adoptive families, and kinship families) in clinical settings 4. How you plan to incorporate the learning from the training program in your clinical practice or agency setting 5. Any personal connection you have with adoption
Partial Scholarships Available
A partial scholarship that would reduce the cost of TAC to $250 is available for applicants with a financial need. Use the space below to briefly explain why you would benefit from being awarded a TAC scholarship. Include current situations (e.g., reduced family income, household expenses, or a shortfall in your finances) that impact your ability to pay the full tuition.
Preferred start date*
Please choose when you would like to begin the program.
- Spring 2022: Session begins January 2022
- A future start date to be determined
Preferred training day*
Indicate your preferred day of the week for training.
- Friday
- Saturday
If Other enter preferred day of the week
How did you hear about the TAC program?*
If Other enter how you learned about the program.
Attach your current resume*
Acknowledgement Statement
- I understand that if accepted for the TAC program, I will be expected to pay the program tuition of $500 unless awarded a scholarship. Tuition is nonrefundable and due upon notification of acceptance in the program.
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College/ University	Major	Degree	Year of Degree

College/ University	Major	Degree	Year of Degree

Date (list most recent first)	Agency or Private Practice Setting (name, address)	Supervisor	Nature of Practice

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Training for Adoption Competency Student Application

Education

Licensure Information