Title IV-E Application Cover Form and Application and Supervisor Approval Form

Transcription

1 Page 1 of 5 Title IV-E Application Cover Form and Application and Supervisor Approval Form Region 8 Master of Social /Child Protective Services Stipend EMPLOYEES ONLY The Texas Department of Family and Protective Services and the University of Texas-at San Antonio offers a stipend for each semester to Texas Department of Family and Protective Services employees. The employee contracts to do their field placements with Child Protective Services and continue to work full time for the agency after graduation for four (4) calendar months for each academic unit/semester that the student received a stipend. Please consider the affect that this stipend would have on your financial aid package when considering your stipend application. The complete stipend application packet must have the following contents and be received by the deadline determined by the region. Name Cover sheet with identifying information to include name, current unit assignment, telephone number, and total number of years and months with CPS.(This form) A copy of most current performance evaluation. A written statement from the supervisor addressing current worker performance level, adherence to work rules, and ability to succeed in an MSW program. A memo (limited to one typed page) to the selection committee that answers the question: Why should you be selected to receive this stipend? The Application and Supervisor Approval Form All application materials are accepted as electronic documents ONLY. Send ALL SWEPT application materials to: Jolyn.mikow@utsa.edu Social Security # date of birth Student ID# TDL# TDFPS employee # Mailing address Home Physical address Home address Personal Phone numbers Home/cell GPA and type of undergraduate degree when employee will begin SWEPT program Unit number Program area & Job Title Total Years/Months ing at CPS Supervisor/ PD name Anticipate to graduate date:

2 Page 2 of 5 Section I: TITLE IV-E CPS STIPEND PROGRAM APPLICATION AND SUPERVISOR REFERENCE This form must be completed as part of the application process to the Title IV-E CPS Stipend Program and at the conclusion of each semester. The CPS employee applying to the CPS Stipend Program should complete Section I of the form. Their direct manager should complete Section II of the form. The form should then be provided to the Regional Operations Support Administrator (ROSA). Employee s Name: Current Job Title: Stage of Service: Employee ID: Hire : Unit Number: As an employee of the Texas Department of Family and Protective Services, Child Protective Service, I agree to follow all agency educational policies and procedures. Employee Signature Section II: It is the responsibility of the supervisor to complete Section II of this form when their employee applies for the Stipend Program and then at the conclusion of each semester. Supervisor Name: Has the employee been employed with CPS for a minimum of one year? Is the employee meeting or exceeding agency expectations? Will this employee be able to carry the additional responsibilities of school and maintain their workload? Has the quantity of the employee s work met the supervisor s expectations and agencies policies? Has the quality of the employee s work met the supervisor s expectations and the agencies policies?

3 Page 3 of 5 Does the employee show initiative, planning, and organization in their day-to-day work activities? Does the employee show flexibility and adaptability to their work activities? Has there been any conflict between the employees work and school schedule? If the employee has not yet started school, please provide details on how conflicts will be handled should they arise. Will this employee attending school negatively impact the unit in which the employee works? Unit needs have to be considered in this approval. Is this employee in a Title IV-E eligible position? Title IV-E Eligible Positions Checklist must be attached (see attachment 1). Do you recommend that this employee be approved or continue to receive Title IV-E Stipend compensation? Supervisor Signature Reviewed by: Second Line Supervisor Signature Third Line Supervisor Signature (if appropriate)

4 Page 4 of 5 Title IV-E Stipend Application Outcome: Approved: Denied: Approval Signatures: Regional Operations Support Administrator Comment: Regional Director Comment: cc: Employee Supervisor Program Administrator/Division Administrator Regional ROSA File Employee Personnel File Title IV-E Eligible Positions Circle the employees position on the chart below Subject Matter Experts (SME) Direct Delivery-FGDM Disability Specialist Family Group Decision Making Specialist Education Specialist FGC Coordinator Intensive Adoption Support Specialist Direct Delivery-Kinship Youth Specialist Kinship Program Director Program Support Kinship Program Director Admin Tech Permanency Practitioner Kinship Supervisor Foster Care Eligibility Supervisor Kinship Admin Tech Foster Care Eligibility Specialist Kinship er Foster Care Eligibility Admin Support Kinship er Direct Delivery-Funct Unit-CVS Direct Delivery-Other Program Director-CVS Program Director Admin Support Program Director-CVS-Admin Support Centralized Placement Supervisor CVS Supervisor Centralized Placement Caseworker CVS Supervisor Centralized Placement Admin Support CVS Caseworker I SEE YOU Supervisor CVS Caseworker I SEE YOU Caseworker CVS Unit Admin Tech I SEE YOU Admin Support CVS Unit Admin Tech PAL Supervisor CVS Unit HST PAL Caseworker CVS Unit HST PAL Admin Support Direct Delivery-FAD* SMEs-Direct Reports to SO Program Director-FAD CPS Res Treatment Placement Coordinator Program Director-FAD Admin Support FAD Trainer

5 Page 5 of 5 FAD Supervisor FAD Caseworker * FAD Caseworker * FAD Recruiter FAD Faith Based Caseworker FAD Admin Tech FAD Unit HST *FAD caseworkers must be "licensing/verifying" foster homes to qualify.