DFCS Education and Training Services Section
  Title IV-E Child Welfare Education Program Application Page 1  
Dear Applicant:

Prior to submitting a Title IV-E Grant application, you must be fully admitted to a participating school of social work in Georgia. This application must be completed online. It requires personal information, three (3) professional references with telephone numbers, brief responses to eight questions.

All information requested in this application is required for admission to the Title IV-E program. You are encouraged to be thoughtful, but concise in your responses to the eight required questions. These responses are considered in the selection process. You may cut and paste your responses from a word processing document if you wish.

General Information
First Name        MI        Last Name    
Social Security Number     - -     Form: 000-00-0000
Have you ever been dismissed from any State of Georgia government position?     Yes    No
If you answered Yes, please provide a detailed explanation.
Are you currently employed by the Georgia Division of Family and Children Services?   Yes     No
If you answered No to the previous question, please answer the following question.
If not employed by DFCS, are you currently employed in a social work position?  Yes    No
If you answered Yes, for which agency do you work?

What is your position at this agency?

How many years of child welfare experience do you have?
Year(s) and Month(s)
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