Training for Adoption Competency Student ApplicationTraining for Adoption Competency Student Application 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 AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business PhoneMobile PhoneEmail EducationUndergraduate EducationCollege/ UniversityMajorDegreeYear of Degree Graduate EducationCollege/ UniversityMajorDegreeYear of Degree Licensure InformationType of LicenseState of LicensureAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces PacificLicense NumberDate through which license is current Date Format: MM slash DD slash YYYY Clinical ExperienceDate (list most recent first)Agency or Private Practice Setting (name, address)SupervisorNature of Practice Personal StatementPlease 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 AvailableA 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 datePlease choose when you would like to begin the program. Spring 2020: Class begins in May 2020. Meeting day/location to be determined.Fall 2020: Class begins in October 2020. Meeting day/location to be determinedPreferred training dayIndicate your preferred day of the week for training. Friday Saturday How did you hear about the TAC program?Direct mail brochureEmail or mailing from DFCSEmail or mailing from another organizationConference or trainingA former or current TAC participantOtherIf Other please describeAttach your current resumeAcknowledgement 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.