TCCW Stipend Program Handbook by University of Tennessee at Chattanooga Child Welfare Initiative

Table of Contents January 2009 Overview of Title IV-E BSW Program……………………………………………………

Roles and Responsibilities of the Title IV-E BSW Program University Coordinator…….

Title IV-E BSW Program Student Responsibilities ............................................................

TCCW Roles and Responsibilities .....................................................................................

Title IV-E BSW Program Student Application Timeframes Fall Semester Timeframes……………………………………………………….... Spring Semester Timeframes……………………………………………………… Summer Semester Timeframes…………………………………………………….

7 8 9

Critical Dates and Addresses for Title IV-E BSW Program Payments……………………

TITLE IV-E BSW PROGRAM FORMS AND PROCEDURES Application for Tennessee Child Welfare Title IV-E BSW Program (3 pages) ..................

Title IV-E BSW Program Student Application Letter to University Selection Committee.. (For University use and record keeping only)

Tennessee Child Welfare Title IV-E BSW Program Reference Recommendation Form….. (2 pages) (For University use and record keeping only)

Notification of Title IV-E BSW Certification Program Eligibility (BSW Non-Stipend Student)………………………………………………………………. Tennessee Child Welfare Title IV-E BSW Program Application Checklist……………….. (For University use and record keeping)

18 19

Tennessee Child Welfare Title IV-E BSW Program Agreement…………………………… 20 (4 pages) DCS Field Placement Learning Opportunities Checklist (2 pages)………………………… 25 Title IV-E BSW Program Student Incident Report…………………………………………. 27 DCS Graduate Trainee State Employment Application Process………………...…………... 28

Child Welfare Title IV-E BSW Manual

Overview of Title IV-E BSW Program Title IV-E BSW Program This program provides financial support for selected baccalaureate level social work majors who have expressed an interest and made a commitment to work with children and families through employment with the Tennessee Department of Children Services (DCS), upon completion of the social work degree program. By forming a partnership with Tennessee Consortium universities offering undergraduate social work degrees, DCS will help prepare future employees in meeting the challenges brought about by the ever changing focus of child welfare practice and policy. The program provides full-time students, during their Junior and Senior college years of attendance, with tuition and stipend payments to assist the participating student with education and living expenses for a minimum of three semesters and a maximum of four semesters. Upon graduation, participating social work students would be eligible for DCS employment at a higher entry salary level than other newly hired employees with non-social work four year degrees. In return, students participating in the BSW Stipend Program would be required to work for DCS for a minimum of 18 months (three semesters of stipend assistance) or a maximum of 24 months (four semesters of stipend assistance) after graduation. To be eligible to apply for and maintain continued enrollment in the Title IV-E BSW Program, the student must: 1. have at least three semesters and not more than four semesters of undergraduate Social Work courses to take before graduation. 2. be a U.S. citizen or if a qualified alien, provide documentation of their eligibility for work in the U.S. prior to receiving Title IV-E financial assistance. 3. contact the university social work program to obtain information on the Title IV-E BSW Program application process and submit all required documentation to the university Title IV-E BSW Program selection committee for review. 4. if selected by the university Title IV-E BSW Program selection committee and available funding for the program exists, complete the necessary university requirements for the undergraduate social work degree within two years of starting the DCS sponsored Title IV-E BSW Program, unless the student has applied for and been granted a one (1) semester extension for hardship by DCS. 5. successfully complete and receive a minimum grade of “B” for the Child Welfare I & II courses offered by the student’s university. 6. successfully complete the university field placement hours requirement which must include a field placement of a minimum of 370 hours in a Tennessee DCS Field Office. 7. maintain an overall GPA of 3.0 for each semester of financial assistance received under the Title IV-E BSW Program. 8. maintain full-time enrollment status as required by the university’s undergraduate Social Work degree program for each semester of Title IV-E BSW Program financial assistance. 9. receive passing grades for a minimum of 12 credit hours for each semester of Title IV-E BSW Program financial assistance.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

BSW Certification Program Although BSW Certification students receive no Child Welfare Title IV-E BSW Program financial assistance and for this reason are not required to work for DCS after graduation, BSW Certification students are eligible for DCS employment at a higher entry salary level than other newly hired employees with non-social four year degrees. To qualify as a BSW Certification student, the student must: 1. complete the necessary university requirements for the undergraduate social work degree, and 2. successfully complete and receive a minimum grade of “B” for the Child Welfare I & II courses offered by the student’s university, and 3. successfully complete the university field placement hours requirement which must include a field placement of a minimum of 370 hours in a Tennessee DCS Field Office.

Roles and Responsibilities of the Title IV-E BSW Program University Coordinator Recruitment/Enrollment/Monitoring of Students Recruitment of quality students into the program that will excel as employees of the Department Ensure student slots are available for university recruitment purposes Utilize the recruitment DVD to assist in the explanation of the program(s) to students Support students and serve as their advocate through the process of enrollment Ensure that students meet all the following requirements for enrollment and/or monitor on an ongoing basis: Title IV-E BSW Student - must be in good standing with the University - must have at least 3 semesters but no more than 4 semesters to complete prior to graduation - must submit to a criminal background check and meet DCS employment requirements - must be enrolled as a full time student each semester - receive passing grades for a minimum of 12 credit hours for each semester of assistance - must maintain an overall GPA of 3.0 for each semester of Title IV-E BSW Program assistance - must understand time commitments to work for the Department upon graduation - must have received an undergraduate social work degree - must have completed and passed Child Welfare I & II courses with a minimum grade of “B” - must have successfully completed a field placement of a minimum of 370 hours in a Tennessee DCS Field Office BSW CERTIFICATION STUDENT - must have received an undergraduate social work degree - must have completed and passed Child Welfare I & II courses with a minimum grade of “B” - must have successfully completed a field placement of a minimum of 370 hours in a Tennessee DCS Field Office Assist DCS regional staff in the planning and coordination of recruitment efforts for students Assist Title IV-E BSW Program students to complete necessary Title IV-E BSW Program application paperwork (see DCS Graduate Trainee State Employment Application Instructions, page 28)

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Check student paperwork for completion and accuracy Coordinate and participate in the University/DCS Title IV-E BSW Program Selection Committee process Route all required documents for appropriate signatures and track to ensure timely completion Route all completed new application documents to Tennessee Center for Child Welfare (TCCW) by the appropriate deadlines: May 1 - Fall Semester – new applying Title IV-E BSW student November 1 – Spring Semester – new applying Title IV-E BSW student November 1 – Spring Semester – new applying Title IV-E BSW Transfer student enrolling for Spring semester or student changing major to BSW for Spring semester March 1 - Summer Semester – new applying Title IV-E BSW student Complete “Critical Dates and Addresses for Title IV-E Program Payments” form (see page 10) and submit to TCCW Finance & Operations Department as soon as the information is available for each semester. Students Enrolled and Continuing in the Title IV-E BSW Program Support students and serve as their advocate through the process of program selection, program participation, graduation and securing employment with the Department of Children’s Services Monitor student’s academic performances during each semester to ensure student success and continued eligibility for the Title IV-E BSW Program. Serve as liaison between TCCW and your university business office, bursar’s office and/or financial aid office to confirm eligibility and academic status of student Verify appropriate enrollment at key points in the semester (last drop date) and submit class schedules and/or grade records to TCCW as back-up documentation of continued eligibility for each student by the following established deadlines: May 15 - BSW grade records for the previous Spring semester July 15 – Fall Semester BSW student class schedules July 31 – BSW student grades for previous Summer semester November 15 – Spring Semester BSW student class schedules December 31 – BSW student grade records for previous Fall semester April 1 – Summer Semester BSW student class schedules August 15 - BSW student grade records for the previous Spring or Summer semester Check student grades to ensure academic progress and submit grade records to TCCW each semester for each participating student within 30 days of grade postings Serve as a liaison with University Social Work Field Placement Coordinator, DCS Regional and Field Staff for student field placement Ensure and monitor on an ongoing basis that Title IV-E BSW students receive appropriate learning opportunities during the DCS field placement Complete the “DCS Field Placement Learning Activities Checklist” (refer to page 25) Monitor student progress on an ongoing basis each semester by meeting with the student, talking with faculty, checking grades and/or talking with DCS field placement contact Notify TCCW Program Coordinator immediately if the student is having academic/field placement difficulties or considering withdrawing from the Title IV-E BSW Program [mail completed “Title IV-E BSW Student Incident Report” (refer to page 27) When necessary, may be asked to serve as a member of a convened Title IV-E BSW Program Review Board to review and advise DCS on any non-academic student performance issue/dispute or identified student violation of the Agreement.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Graduating Title IV-E BSW Stipend and BSW Certification Students Notify TCCW at the beginning of the student’s last semester Notify TCCW and the DCS State Office of Human Resource Development at DCS.Human.Resources@state.tn.us within one month prior to graduation of graduates, this will also include graduating BSW Certification Students. For BSW Certification Students, submit a “Notification of Title IV-E BSW Certification Program Eligibility (Non-Stipend Student)” form (refer to page 18) to TCCW when the student has successfully completed the Child Welfare I & II courses and successfully completed the DCS field placement before the student can be hired by DCS as a Title IV-E BSW Certification Program Student. Advise students of the requirement to complete the State of Tennessee Employment Application (Online Version) at www.state.tn.us/dohr within 60 days but no later than 30 days prior to graduation Assist students with the completion of the on-line job State of Tennessee Employment Application Verify that student has completed State of Tennessee Employment Application and documented on the application form the willingness to relocate to any DCS service region in the state that the Agency has a vacancy.

Title IV-E BSW Program Student Responsibilities BSW student must: meet all application eligibility requirements complete all appropriate paperwork to enroll in the program and verify continued satisfactory participation as a full time student in good academic standing ensure that you meet and understand all the requirements as explained in the Agreement for initial acceptance and continued participation maintain an overall GPA of 3.0 for each semester of Title IV-E BSW Program financial assistance complete all required course work and field placements maintaining appropriate expectations authorize the university to release official grade transcripts and class schedules to the Tennessee Center for Child Welfare upon request communicate with the Title IV-E BSW Program University Coordinator on a regular basis regarding your enrollment/educational status, name changes, reporting any schedule changes or academic problems immediately to the Title IV-E BSW Program University Coordinator submit any non-academic complaints or grievances regarding the terms of the Agreement to the Title IV-E BSW Program Review Board for review and consultation with the Tennessee Department of Children’s Services accept that all decisions of the Title IV-E BSW Program Review Board are final and there is no further appeal available payback in full all financial assistance received in the Title IV-E BSW Program if the student fails to satisfactorily complete academic or field requirements of the undergraduate social work degree, violates the NASW Code of Ethics, is convicted of a crime involving a child or refuses to apply or accept DCS employment notify Title IV-E BSW University Coordinator before the last semester of graduation for assistance with the preparation of the on-line State of Tennessee Employment Application submit an on-line application for employment for the Tennessee Department of Children’s Services within 60 days but no later than 30 days prior to graduation at www.state.tn.us/dohr

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

agree to actively seek employment with the Department of Children’s Services (DCS), by responding to all DCS employment interviews and not declining employment if offered authorize the Tennessee Center for Child Welfare to track the student’s DCS employment for two (2) years after employment if the student terminates (voluntarily or involuntarily) DCS employment prior to completion of the employment requirement, reimburse to DCS the proportion of the financial assistance received in the Title IV-E BSW Program equivalent to the proportion of the employment requirement that remains incomplete as determined by DCS

Tennessee Center for Child Welfare Roles and Responsibilities Program Coordinator Program Development and Management – overall responsibility for the Title IV-E BSW Program. Liaison between DCS and Consortium Universities – Meet in-person or communicate by telephone or e-mail with DCS on a monthly basis regarding program development and problem resolution. Communicate updates, changes and status of programs to participating Consortium universities. Dissemination of Information – Communicate with Consortium universities including Title IV-E BSW Program University Coordinators all changing program policy or procedures. Serve as primary contact for University Coordinators for submission of student correspondence or respond to university inquiries. Preparation of Student Files – Accumulate documents and review for accuracy and completeness before passing to Fiscal Manager for preparation of Third Party Billing Letters. Processing of Student Applicants – Ensure student eligibility and completeness of all paperwork prior to submission of Third Party Billing Letters and stipend and tuition payments. Work closely with the Fiscal Manager on student Third Party Billing Letters and stipend and tuition payments. Problem Resolution – Serve as the primary point of contact for coordinators to resolve specific problems with student issues, participation and payments. Reporting – Prepare reports as requested by TCCW, participating universities and DCS. Database – Maintain Database for tracking of students through graduation and Agreement commitment for DCS employment to ensure employment requirements are met. Tracking- Prepare spreadsheet for the Finance & Operations Director each semester based on verification process.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Fiscal Staff Third Party Billing Letters - Mail to university Bursarâ&#x20AC;&#x2122;s Office or Financial Aid Office after receiving completed application, contract for new students and verification of appropriate enrollment according to Agreement. Fiscal staff must also receive confirmation from the TCCW Program Coordinator that the university coordinators have verified full-time enrollment and other eligibility criteria for each participating student each semester. Stipend - Processing of stipend payments to the universities on behalf of Title IV-E BSW students at the beginning of each semester. Class schedules must be received to process payment. Tuition Invoices - Process payment authorizations of university invoices for tuition and related fees for Title IV-E BSW students after the last drop date of the semester. Must receive notification from Title IV-E BSW Program University Coordinator that student is still enrolled and in good standing. Budgetary - Development and tracking of budget and actual payments for Title IV-E BSW stipends and tuitions. Preparation of fiscal reports related to the program. Assist the TCCW Program Coordinator in the follow up of any missing data.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Title IV-E BSW Program Student Application Timeframes Recruitment and selection of potential Title IV-E BSW Program students should occur during their sophomore year.

For initial enrollment and/or ongoing semester verification in the Fall Semester: May 1st

TCCW will have received all new Title IV-E BSW Program student application packets from the participating universities. Required original signed forms comprising the application packet: “Application for Tennessee Child Welfare Title IV-E BSW Program” form, January 2009 version “Tennessee Child Welfare Title IV-E BSW Program Agreement” form, January 2009 version “Critical Dates and Addresses for Title IV-E Program Payments” form (see page 10) (one form per university per semester)

May 15th

TCCW will have received all grade records for all Title IV-E students who attended the previous spring semester but elected not to enroll in the current summer semester.

July 15th

TCCW will have received all class schedules for the upcoming fall semester for currently enrolled Title IV-E BSW students. Universities will have submitted all required documents to TCCW for Title IV-E BSW students, so that third party billing letters can be sent to each University Bursar’s Office or Financial Aid Office.

July 31st

TCCW will have received all grade records for all Title IV-E BSW students who attended the previous summer semester.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

For initial enrollment and/or ongoing semester verification in the Spring Semester: Nov 1st

TCCW will have received all new Title IV-E BSW Program student application packets from the participating universities. Required original signed forms comprising the application packet: “Application for Tennessee Child Welfare Title IV-E BSW Program” form, January 2009 version “Tennessee Child Welfare Title IV-E BSW Program Agreement” form, Janaury 2009 version “Critical Dates and Addresses for Title IV-E Program Payments” form (see page 10) (one form per university per semester)

Nov 15th

TCCW will have received all class schedules for the upcoming spring semester for currently enrolled Title IV-E BSW students. Universities will have submitted all required documents to TCCW for Title IV-E BSW students, so that third party billing letters can be sent to each University Bursar’s Office or Financial Aid Office.

Dec 31st

TCCW will have received all grade records within 30 days of grade posting for all BSW students who attended the fall semester.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

For initial enrollment and/or ongoing semester verification in the Summer Semester: March 1st

April 1st

TCCW will have received all class schedules for the upcoming summer semester for currently enrolled Title IV-E BSW students. TCCW will accept early registration class schedules for the fall semester for currently enrolled Title IV-E BSW students who are not attending the summer semester.

April 15th

Universities will have submitted all required documents to TCCW for Title IV-E BSW students, so that third party billing letters can be sent to each University Bursar’s Office or Financial Aid Office. TCCW Program Coordinator will have submitted a signed waiver letter from DCS that authorizes new full-time Advanced Standing students who will be graduating in May from the BSW stipend program a delay in the DCS employment requirement until completion of the full-time Advanced Standing MSW/MSSW program.

July 31st

TCCW will have received all grade records within 30 days of grade posting for all BSW students who attended the summer semester.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Critical Dates and Addresses for Title IV-E Program Payments Semester __________________________

Year ____________

Instructions:

Submit the following information to TCCW Program Coordinator, for each semester when the information is released by the institution. This information is typically released by the institution mid-semester of the preceding semester. The accuracy and timely receipt of this information each semester is critical to timely payment of stipend, tuition, and/or expense allowance for the students participating in the program. Mailing address for stipend/expense allowance and tuition payments Please include such things as Bursar’s Office or Attention To: University Name ___________________________________

Contact Name ________________________________

Address __________________________________________

Contact Number ______________________________

_________________________________________

Contact Fax __________________________________

_________________________________________

Contact E-mail _______________________________

City

_________________________________________

Zip Code _________________________________________ (include-xxxx)

Critical Dates Third Party Billing Letter (Fee Payment or Confirmation Deadlines): __/_ _/_ _ _ _

What date will the student lose classes if the third party billing letter is not received and credited to the student’s account? NOTE: The third party billing letter cannot be issued until all appropriate documentation has been received, including signed and completed application, signed agreement, and the student’s class schedule verifying enrollment status.

Classes Begin: _ _/_ _/_ _ _ _

When is the first day of classes? NOTE: This date is used to determine when the stipend payment needs to be issued. TCCW must have grade reports verifying prior semester successful completion of courses prior to release of the stipend payment.

Tuition Payment: _ _ / _ _ / _ _ _ _

What is the last withdrawal date for grades? NOTE: Tuition should not be billed until after the last drop date for withdrawal from classes has passed. The coordinator needs to confirm that the student still meets eligibility requirements for the program after this date. Special note – the last drop date is not the same as the last drop/add date. The last drop date is the date for which a student drops a class without receiving a grade.

Registration: _ _ /_ _/ _ _ _ _

What is the date students begin to register for the next semester (send entire range of registration dates)

Please email responses to: lou.martinez@tccw.org Tennessee Center for Child Welfare

Update January 2009

Title IV-E BSW Program Forms and Procedures

Child Welfare Title IV-E BSW Manual

Tennessee Department of Children Services Application for Tennessee Child Welfare Title IV-E BSW Program Date of Application _ _ / _ _ / _ _ _ _

University ID Number _________________________

Name_________________________________________________________________________ (Print) Last First Middle Maiden Name Permanent Address______________________________________________________________ (Print) Street or Box No. City State Zip Code Telephone Number (_____) __________________ Email Address:_______________________ Current Address _______________________________________________________________ (Print) Street or Box No. City State Zip Code Current Telephone No. (_____) _______________ School Email Address _________________

Date of Birth _ _ / _ _ / _ _ _ _ Month Day Year

Are you a U.S. citizen? _____ Yes _____ No

Are you a Tennessee Resident? ____ Yes ____ No In which Tennessee County? ____________ The following information is being gathered in this block for compliance with federal laws. Your responses are voluntary. Any information provided will be kept confidential. If you do not choose to answer these questions, you will not be subject to any adverse treatment in the application process. Gender: [ ] Male Race:

[ ] Female

[ ] Alaskan Native [ ] Black

[ ] Native American Indian

[ ] Hispanic

[ ] White

[ ] Asian or Pacific Islander [ ] Other

University currently attending _____________________________________________________ Overall G.P.A. ________________________ Social Work G.P.A. ________________________ Anticipated semester and year of graduation_________________________ Do you speak any additional language(s) ____Yes ____No If YES, please list: ____________

cc: Department of Childrenâ&#x20AC;&#x2122;s Services, State Office of Human Resource Development Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Have you taken or are you currently enrolled in any college level Spanish classes? _____Yes _____No If YES, please list: ___________________________________________

Have you ever been convicted and/or currently on probation for any misdemeanor or felony charge(or any equal offense under military law)? If yes, give details on a separate sheet of paper for each conviction. Include (1) date, (2) charge, (3) place, (4) court, and (5) action taken. You must disclose any conviction involving a sentence or suspended sentence. You may omit: (1) any offense committed before your 18 th birthday which was finally adjudicated in a juvenile court; (2) any conviction which has been expunged under Federal or state law. A conviction will not necessarily disqualify you from the Title IV-E BSW program. A conviction will be evaluated on its own merits with respect to time, circumstances, and seriousness. _____ YES _____ NO Have you ever been identified as an indicated perpetrator of child abuse or neglect by the Tennessee Department of Children’s Services or in any other state? _____ YES _____ NO If yes, provide dates and an explanation and attach to this application. Prior to the beginning of the DCS office field placement that is required by the Tennessee Child Welfare Title IV-E BSW Program and later for employment with the Tennessee Department of Children’s Services, I agree to submit to criminal background checks. I agree to submit to the Tennessee Bureau of Investigation Sexual Offenders Registry check by the Tennessee Department of Children Services to determine if my name is identified on the registry maintained by the TBI in accordance with Tennessee Code Annotated 40-30-106. I further understand that, upon receipt of the results of the criminal background, CPS perpetrator records, and Sexual Offenders Registry checks, the Tennessee Department of Children’s Services (DCS) may disqualify me from participating in the DCS office field placement or from DCS employment. As part of the Tennessee Department of Children’s Services volunteer and/or hiring application process, I agree to be fingerprinted and authorize the release of any investigative and criminal records obtained by the Federal Bureau of Investigation and the Tennessee Bureau of Investigation to the Department of Children’s Services (TCA 38-6-114; TCA 71-3-533). If accepted into the Title IV-E program, I agree to release verification of grades, maintain a positive academic standing and appropriate progress toward the degree and immediately notify my Title IV-E University Coordinator of any problems with the above. __/__/____ Date

________________________________________________ Signature of Applicant

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Students, accompanied by Department of Children’s Services (DCS) personnel, must be able to respond quickly to emergency calls. When accompanying DCS staff, they will need to be able to make emergency home visits throughout their DCS office’s geographical area, entering various types of dwellings – trailers, homes, apartments, etc. Do you have any limitations that could interfere with your performing such demanding work? _____ YES _____ NO If yes, please explain: ____________________________________________________________

Please Note: DCS shall attempt to place the students in the DCS service region of their choice, if possible. If DCS determines based upon current staffing levels there are no employment opportunities in the DCS service region of the student’s choice, the student will be required to accept a position in another DCS service region.

Certification and Agreement I certify that the forgoing information provided by me is true and complete to the best of my knowledge and understand that any willfully false statement is sufficient cause for rejection of this application or, if Title IV-E financial assistance has been awarded, for the termination of this award and repayment of funds received. I understand that the Tennessee Child Welfare Title IV-E BSW Program is a joint effort of the University and the Tennessee Department of Children Services, and this application will be reviewed by both entities.

__/__/____ Date

_____________________________________________ Signature of Applicant

University Office Use Only Date Application Received by University: _____/_____/_____

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Title IV-E BSW Program Student Application Letter to University Selection Committee (for University Selection Committee review and record keeping only)

Applying student needs to complete and attach a three or four page paper to this application which responds to the following:

If you had to explain the term â&#x20AC;&#x153;child welfareâ&#x20AC;? to someone, what would you say?

Why are you interested in the field of public child welfare?

What qualities do you feel that you have that would make you a good public child welfare worker?

Discuss areas where you need further exposure, growth, and development in order to become an effective child welfare worker.

Describe your short-term (5 years from now) and long-term goals.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Tennessee Child Welfare Title IV-E BSW Program Reference Recommendation Form (for University Selection Committee review and record keeping only) TO THE TITLE IV-E BSW PROGRAM APPLICANT: Please print your name: ______________________________________________________ Please request reference statements from three (3) persons who have recent knowledge about your qualifications. Ask each of them to send it back to you in a sealed envelope after signing across the seal. Submit those unopened letters together with your application. References must not come from relatives. Include, if possible, a) one employer and b) one supervisor from your volunteer work at an agency, and c) one faculty member excluding social work faculty. YOUR SIGNATURE IS REQUIRED ON THIS FORM. Under the Family Educational Rights Act of 1974, students are entitled to review their records, including letters of recommendation. It is your option to waive your right to review this recommendation, or you may decline to do so. If you waive your right to review your recommendation forms, these evaluations will be considered confidential and will not be available for your inspection should you be accepted for admission to the program. Please mark the appropriate statement below, indicating your choice of option, and sign your name. ____________________ I waive my right to review this recommendation. ____________________ I do not waive my right to review this recommendation.

Applicantâ&#x20AC;&#x2122;s signature (REQUIRED): _______________________________________________ Date: _ _ / _ _ / _ _ _ _

Name (print): __________________________________________

TO THE REFERENCE: You have been asked to complete an evaluation of the above named individual who is applying for admission to the Tennessee Child Welfare Title IV-E BSW Program. Your candid opinion will be of great assistance to us in evaluating his/her application. Your comments will be confidential if the applicant has waived right to review. All recommendations are destroyed once an applicant has been approved for admission. (Note: Applicants not approved for admission have no access to their file.) To help the University Selection Committee make an informed decision on the applicantâ&#x20AC;&#x2122;s suitability for the program, please answer the following questions.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

How long and in what capacity have you known the applicant? ______________________________________________________________________________

Please evaluate the applicant in each of the following areas: Limited Average 1 2 3

High 4 5

Can’t Judge 6

Level of Maturity and Emotional Stability Understanding of Self Sensitivity to Needs and Feelings of Others Ability to Respect and Work with Differences in People (i.e. race, class, culture, ethnicity, sexual orientation) Oral Communication Skills Written Communication Skills Ability to Work with Others Ability to Accept Constructive Feedback 3.

In your opinion, what are the applicant’s major strengths? ______________________________________________________________________________ ______________________________________________________________________________

In your opinion, what are the applicant’s weaknesses? ______________________________________________________________________________ ______________________________________________________________________________

I would: ______ Recommend without reservation ______ Recommend ______ Recommend with reservation ______ Not recommend

Signature: _______________________________________________ Date: _ _ / _ _ / _ _ _ _ Name (print or type): ______________________________________ Date: _ _ / _ _ / _ _ _ _ Organization: ________________________________________ Telephone: ________________

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Tennessee Department of Children’s Services Notification of Title IV-E BSW Certification Program Eligibility (BSW Non-Stipend Student) Date of Notification: _ _ / _ _ / _ _ _ _ University ID Number___________________________ Name_________________________________________________________________________ (Print) Last First Middle Maiden Name Permanent Address______________________________________________________________ (Print) Street or Box No. City State Zip Code Telephone Number (_____) __________________ Email Address:_______________________ Current Address _______________________________________________________________ (Print) Street or Box No. City State Zip Code Current Telephone No. (_____) _______________ School Email Address _________________ Date of Birth _ _ / _ _ / _ _ _ _ Month Day Year

Are you a U.S. citizen? _____ Yes _____ No

[ ] Female

[ ] Alaskan Native [ ] Black

[ ] Native American Indian

[ ] Hispanic

[ ] White

[ ] Asian or Pacific Islander [ ] Other

Received at least a “B” in both Child Welfare I and II courses ____Yes ____No Completed DCS office field placement of a minimum of 370 hours ____Yes ____No County of DCS field placement? _________________________________ University currently attending ___________________ Date of graduation _ _ / _ _ / _ _ _ _ Overall G.P.A. ________________________ Social Work G.P.A. ________________________ Do you speak any additional language(s) ____Yes ____No If YES, please list: ____________ Signature _____________________________________________

Date _ _ / _ _ / _ _ _ _

cc: Department of Children’s Services, State Office of Human Resource Development

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Tennessee Child Welfare Title IV-E BSW Program Application Checklist (for University Title IV-E Coordinator application packet review and record keeping only)

Studentâ&#x20AC;&#x2122;s name: ___________________________

Semester ______________ Year ______

1. [ ] Applicant submitted three (3) letters of recommendation.

2. [ ] Verified the applicant has a valid motor vehicle operator license.

3. [ ] Verified the applicant meets the necessary grade point average requirement for the undergraduate social work degree program.

4. [ ] Verified the applicant has a minimum of three semesters remaining prior to graduation, but no more than four (4) semesters. Full-time summer term enrollment may be considered a semester, provided that the student is taking courses required by the undergraduate social work degree program for graduation.

5. [ ] All required information and signatures were recorded on the Application for Tennessee Child Welfare Title IV-E BSW Program, and Tennessee Child Welfare Title IV-E BSW Program Agreement* These two documents comprise the application packet.

6. [ ] The application packet was submitted to the Tennessee Center for Child Welfare (TCCW) Program Coordinator.

*Please make sure all forms are completed prior to submission to TCCW. Blanks or incomplete information on any form can cause a delay in the processing of the application paperwork.

Tennessee Center for Child Welfare

Update January 2009

Child Welfare Title IV-E BSW Manual

Tennessee Child Welfare Title IV-E BSW Program Agreement Between Tennessee Department of Children’s Services And ___________________________________, STUDENT The TN Department of Children’s Services (hereafter referred to as the “Agency”) and ______________________________ (hereafter referred to as the “Student”) do hereby make and enter into this mutual agreement for the academic semester starting _____________ / ______ as specified below: (semester) / (year) I.

The Agency Agrees to: A. Pay the student’s university in-state semester tuition and fees as a full-time (as defined by the Student’s university) undergraduate student, pursuing an undergraduate degree in Social Work at one of the eleven (11) universities participating in this program (Austin Peay State University, East Tennessee State University, Freed Hardeman University, Middle Tennessee State University, Southern Adventist University, Tennessee State University, Union University, University of Memphis, University of Tennessee at Chattanooga, University of Tennessee at Knoxville, and University of Tennessee at Martin). Students pursuing an undergraduate degree in Social Work at the in-state private institutions of Freed Hardeman University, Union University, or Southern Adventist University, will be required to pay the difference between the highest semester tuition of the eight (8) participating public universities and the semester tuition cost at the four private institutions. A Student must have a minimum of three (3) semesters or maximum of four (4) semesters remaining before graduation in order to qualify for this program. Full-time summer term enrollment (as defined by the student’s university) can be considered a semester provided that the student is taking courses required by that university’s undergraduate Social Work degree program. For universities charging per credit hour for summer term enrollment, the maximum number of credit hours financially covered by this agreement will be twelve (12) credit hours. Not pay the tuition and fees and corresponding stipend payment a second time for any course in which the student did not receive a passing grade (as defined by the student’s university undergraduate social work degree program). If the Student receives a grade of “incomplete” for any course paid under this program, the Student must successfully complete this course and receive a passing grade within (1) semester of receiving the first “incomplete” for this course. Provide a stipend payment to be used for the purchase of textbooks, living expenses and reimbursement for travel expenses related to participating in this program. The amount of the stipend will be re-evaluated and if necessary, readjusted at the beginning of each new academic year (fall semester). The summer stipend amount is less than the spring and fall semester amounts. The Student will not receive tuition and stipend payments for more than four (4) semesters. The tuition and stipend payments will be paid directly

Tennessee Center for Child Welfare

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Child Welfare Title IV-E BSW Manual

to the Student and the tuition and stipend payments will be considered by the financial aid or business office as part of the student’s overall financial aid package. In the event that the Agency reduces the stipend amount received by the Student, the Agency will provide the university Title IV-E BSW Program Coordinator and the Student with a thirty (30) day notice of its intention to reduce the stipend payment amount. C. Assist the Student in acquiring employment consistent with state personnel employment requirements for a Family Service Worker or Graduate Trainee position within the Agency. Nothing in this agreement shall obligate that the Agency employ the Student. The job position and work location will be determined by the Agency and will be subject to change at the discretion of the Agency. The Agency shall attempt to place the Student in the DCS service region of choice, if possible. If no position is available in the DCS service region of choice, the Student will be required to accept a position in another service region in Tennessee. D. Not hold the Student responsible for repayment of the remaining amount of financial assistance received through the Agreement if the Student’s employment is terminated by the Agency due to a reduction-in-workforce before completion of the employment requirement under the terms of this Agreement. II.

The Student Agrees to: A. Complete the necessary academic requirements for the undergraduate social work degree program of the Student’s selected university within two years of beginning this program, unless the student has applied for and been granted a one (1) semester extension for hardship by the Agency. As part of the necessary requirements, the Student will be required to successfully complete and receive a minimum grade of “B” for the Child Welfare I & II courses offered by the Student’s university and successfully complete a field placement of a minimum of 370 hours in a Tennessee DCS Office. B.

Maintain an overall GPA of 3.0 for each semester of financial assistance received under the terms of this Agreement.

Maintain full-time status in the fall, spring or summer semesters (as defined by the Student’s university) for each semester of financial assistance received under the terms of this Agreement. The minimum number of credit hours to qualify as full-time enrollment cannot include the credit hours for any failed course being taken a second time.

Receive passing grades for a minimum of twelve (12) credit hours for each semester of financial assistance received under the terms of this Agreement.

Attain a passing grade within (1) semester of receiving a grade of “incomplete” for any course paid under this Agreement.

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Child Welfare Title IV-E BSW Manual

F. Attend all student meetings, orientations, trainings, retreats and conferences associated with this program. G. Promptly pay for any other tuition, fees or other school-related expenses, which are not specified as being paid by the Agency in this agreement. H. Immediately inform the Title IV-E BSW Program University Coordinator of any academic problems, name and personal contact information changes or when dropping/withdrawing from a course during the semester. I.

Submit any non-academic complaints or grievances regarding the terms of the Agreement in writing to TCCW for review by the Title IV-E BSW Program Review Board and consultation with the Tennessee Department of Children’s Services.

J. Authorize the University to submit to the Tennessee Center for Child Welfare and the Agency all required documentation each semester, such as class schedules and grade records, for the verification of enrollment status and satisfactory course completion. K. Inform TCCW and the Agency if the Student must interrupt his/her studies and/or delay graduation or required employment due to personal hardship. The Student may request permission from the Agency to delay the employment obligation requirement. This written request should indicate when the Student intends to recommence and complete the program. Medical documentation, university faculty and/or Title IV-E BSW Program Coordinator notes should be attached to the written request. DCS will respond in writing within 30 days of receipt of the Student’s written request. L. Apply for and accept full-time employment with the Tennessee Department of Children’s Services in a Family Service Worker or Graduate Trainee position in the Department of Children’s Services. The Student must follow state personnel procedures for hiring and must submit electronically an employment application to the State of Tennessee Department of Human Resources within sixty (60) days and no later than 30 days prior to graduation. The application must document the willingness to accept a position in any DCS service region in the state that the Agency has a vacancy. M. Actively seek employment with the Agency, by responding to or not declining to all Agency employment interviews and accepting any position offered by the Agency for which the Student is qualified. In the event that the Agency determines that the Student intentionally failed the employment interview(s), so as not to be offered a job position, the Student must repay the amount of financial assistance received under the terms of this Agreement. N. Authorize the Tennessee Center for Child Welfare to track the Student’s Agency employment for two (2) years after Agency employment. O. Successfully complete the initial probationary period for the Family Service Worker or Graduate Trainee position and based upon the number of semesters the student received

Tennessee Center for Child Welfare

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Child Welfare Title IV-E BSW Manual

tuition/stipend payments, remain employed with the Agency for a minimum of eighteen months (3 semesters of assistance) or two years (4 semesters of assistance) after graduation. P. Repay the Agency the cost of tuition and stipend paid by the Agency to the university and the Student if the Student fails to meet any of the terms of this Agreement. Repayment will be made in a manner and time frame determined by the Agency. In the event of litigation related to repayment of tuition and stipends paid by the Agency, the Student will be required to pay all attorney fees, court costs and/or any other ancillary costs associated with the collection process. III. Cancellation of this Agreement A. During the period of this agreement the Agency may cancel the Student’s participation in the Certification Program for “cause”. “Cause” may include, but is not limited to, breach of any term of this Agreement, breach of the NASW Social Work Code of Ethics, failure to maintain required academic standards, violation of school rules resulting in disciplinary action, conviction of a crime involving a child, and any actions which would result in separation or dismissal under the state personnel laws. Should this agreement be cancelled for “cause” the Student will repay the Agency as outlined in Section II, paragraph P. B. In the event of changes in funding for this program, the Agency reserves the right to terminate the Agreement at any time. However, if the Agreement is terminated due to “no fault” on the part of the Student, the Student will not be obligated to make any repayment to the Agency. C. All non-academic disputes arising from this agreement shall be submitted to in writing to TCCW for review by the Title IV-E BSW Program Review Board and consultation with the Agency. There is no further appeal available and the decision of the Title IV-E BSW Program Review Board will be considered final. D. If hardship, such as death, personal illness, permanent disability or failure to find Agency employment within one (1) year after graduation due to no fault of the student, the student must make a request in writing to the Agency, requesting permission to waive the employment requirement. The circumstances supporting the request must be fully documented with evidence, e.g. medical documentation, employer notes, evidence of comprehensive Agency employment search, etc.

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Child Welfare Title IV-E BSW Manual

IV. Period of the Agreement This agreement shall cover the academic year starting _________________ (semester) _________ (year) plus an equal amount of time of full-time required employment with the Agency thereafter as stipulated in Section II, paragraph O. Name of University _______________________________________________________ University ID Number _____________________________________________________ I do hereby confirm that I fully understand the above terms of this agreement and do hereby agree to abide by them as a participant in the Tennessee Child Welfare Title IV-E BSW Program. ______________________________________________ Student

__/__/____ Date

______________________________________________ DCS â&#x20AC;&#x201C; Appointing Authority or Designee

__/__/____ Date

Original to: Copies to:

TCCW Program Coordinator Student and Title IV-E University Coordinator and Tennessee Department of Childrenâ&#x20AC;&#x2122;s Services

Tennessee Center for Child Welfare

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Child Welfare Title IV-E BSW Manual

DCS Field Placement Learning Opportunities Checklist Student’s Name: _______________________________________ Semester _____________ Year _________ University: ________________________________________________________________________________ 1. Skill Demonstration

initial

a. Conducting a supervised family centered assessment ................................................................ b. Work with a family team on building/revising a case plan in a supervised setting. ..................... Comments:_____________________________________________________________________

2. Documentation a. Attend TN Kids core courses. ................................................................................................... Comments:____________________________________________________________________

Self-Directed Readings a. Completing program specific policy readings as determined by the team. b Reading assigned resource articles in the OJT Participation Guide in preparation for the .......... field placement. ........................................................................................................................ Comments:_____________________________________________________________________

4. Field Observations a. Observing an experienced case manager facilitate a Child & Family Team Meeting. ................. b. Completing a “Child & Family Team Meeting Observation Form” after observing a Child & Family Team Meeting. ............................................................................................................. c. Meeting briefly with the DCS Field Contact and experienced case manager to discuss the student’s observations of the Child & Family Team Meeting and regional protocol related to Child & Family Team Meetings. ............................................................................................... d. Observing Juvenile Court dependency and neglect proceedings (adjudication and/or dispositional hearings). ............................................................................................................. e. Observing a CPS intake. ........................................................................................................... f. Observing a Child Abuse Review Team (CART) meeting. ........................................................ g. Observing a Child Protective Investigative Team (CPIT) meeting. ............................................ h. Observing a CPS removal. ........................................................................................................ i. Observing a Foster Care Review Board (FCRB) meeting. ........................................................ j. Observing a Permanency Planning staffing. .............................................................................. k. Observing a parent/child visitation. ........................................................................................... l. Observing a home visit with a birth parent, foster parent, or adoptive parent. ............................ m. Observing a relative or kinship home study or background check. ............................................. n. Observing a case transfer to an ongoing service unit and/or agency. .......................................... o. Observing an Independent Living Life Skills class. ................................................................... p. Observing a Youth Advisory Council meeting. ......................................................................... Comments:_____________________________________________________________________

5. Specialty Week Training a.

Attended Specialty Week Training Course. ................................................................................

Comments :_________________________________________________________________

____________________________________________________________ DCS Field Contact

__/__/____ Date

____________________________________________________________ Student

__/__/____ Date

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Child Welfare Title IV-E BSW Manual

initial

6. Working with DCS Field Placement Contact and DCS Field Staff a. The DCS Field Contact dedicated sufficient time to assist the student with his/her learning. ...... b. The DCS Field Contact answered questions to the studentâ&#x20AC;&#x2122;s satisfaction. .................................. c. The DCS Field Contact seemed concerned with whether the student learned what the student needed for working effectively with children and families............................................. d. The DCS Field Contact let the student know the student was doing a good job when the student demonstrated learned skills during his/her field competency assessments. ............... e. The DCS team leader organized activities in a manner that reinforced university classroom training. ................................................................................................................... f. The DCS Team Leader expected the student to conduct interviews with families following the family centered, strength based, and culturally sensitive practice model. ............................. g. The DCS Team Leader dedicated sufficient time to assist the student with his/her learning. ...... h. DCS staff conducted interviews with families following the family centered, strength based, and culturally sensitive practice model. ..................................................................................... Comments ... :____________________________________________________________________

_____________________________________________________________________ 7. Overall Satisfaction a. Adequate time was allocated in the field placement to practice skills introduced in the university classroom. ................................................................................................................ b. Too many activities were planned during the studentâ&#x20AC;&#x2122;s field placement time. ............................ c. Activities increased the studentâ&#x20AC;&#x2122;s confidence in working collaboratively with children and families. ............................................................................................................................. Comments ... :____________________________________________________________________ ...... _____________________________________________________________________

____________________________________________________________ University Field Liaison

__/__/____ Date

____________________________________________________________ Student

__/__/____ Date

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Child Welfare Title IV-E BSW Manual

Title IV-E BSW Program Student Incident Report Studentâ&#x20AC;&#x2122;s name:

___________________________________________________________________

Name of University: `__________________________________________________________________ Semester/Year

_____________________________________/_____________________________

Name of person making report: __________________________________________________________ Job Title:

___________________________________________________________________

Telephone number:

___________________________________________________________________

Date:

_______/_______/_______

Report is on (please check)

Academic performance Field placement Other ______________________________________________

Details of problem, concern, or issue reported (attach extra pages if needed or student may attach addendum): _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Steps taken by University in response to reported problem, concern or issue: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________ Signature of person making report:_________________________________________________________ Signature of Student: ___________________________________________________________________ Steps taken by TCCW in response to reported problem, concern or issue: _____________________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________

_____________________________________________________ Signature of TCCW Program Coordinator Tennessee Center for Child Welfare

__/__/____ Date Update January 2009

Child Welfare Title IV-E BSW Manual

DCS Graduate Trainee State of Tennessee Application Process Complete Online Application Because the Tennessee Department of Human Resources (D.O.H.R.) requires applications to be completed online, please go to the following website to complete your application: www.state.tn.us/dohr Once on the www.state.tn.us/dohr website: Click on “Apply for Employment,” link, bottom right of page Once on the page titled, “Tennessee Career Service Employment Information,” click on “Current Openings’ link which is located in the first paragraph of the page Once on the “Current openings” page, scroll down the page until you find the listing for “Graduate Trainee” Click on the link for “Graduate Trainee” Once on the “Graduate Trainee” page, click on the “Apply” link. Note: The first time you access the application, the system will prompt you to register with NeoGov and create your own personal account. When completing the application, DCS has requested that you: List your personal cell phone number (if you have one) in the documentation field for “Alternative Phone.” Under the “Preferences’ section, answer Yes to the question, “Are you willing to relocate?” Under the “Education History” section, answer Yes, I graduated from this school for the question, “Did you graduate?” Answer Yes only if you will graduate within 120 days of submitting the application, List your BSW field placement experience under the “Work History” section. Document the total number of hours of your field placement for each duty detailed in the “Duties Detailed” section. Under the “References” section, submit at least two but no more than three references. Under the “Resume” section, copy and paste your resume into the “Text Resume” box or click on the “Browse” button at the bottom of the page to attach your resume. Under the “Agency Wide Questions” section, Question 10 – County Preferences, select Statewide instead of an individual county or counties. Once you have completed the application, make sure to certify and submit your application. Submit your application prior to the Closing Date/Time that is listed for the job posting. Applications submitted after the Closing Date/Time will not be accepted. Make sure you print a copy of your application upon completion so that you have a copy of it to bring to your DCS interview(s).

Tennessee Center for Child Welfare

Updated January 2009