Social Services Training Registration Form
FTM Training for Facilitators– Private Providers
THIS FORM IS TO BE USED TO REGISTER PRIVATE SERVICE PROVIDERS ONLY
DO NOT USE THIS FORM FOR DFCS EMPLOYEES
Fax the completed form to: Fax: 404-413-1047
DFCS employees must register using the DFCS Registration and Transcript System:
www.gadfcs.org/transcript
PLEASE PRINT! PLEASE PRINT! PLEASE PRINT!
DATE:
A)
B)
ATTENDEE INFORMATION
NAME:
/
/
DFCS CONTACT PERSON INFORMATION
NAME:
Name of DFCS supervisor/administrator who authorized
your attendance and will coordinate field practice
AGENCY:
DFCS
COUNTY
OFFICE
SERVED:
COUNTY/
REGION:
EMPLOYEE ID#:
OFFICE USE ONLY
JOB TITLE:
TELEPHONE #:
TELEPHONE #:
(In case of cancellation due to emergency.)
EMAIL:
FAX#:
FAX #:
E-MAIL:
E-MAIL:
Enter a
complete and
accurate
Email address
Enter a
complete and
accurate Email
address
C)
SECTIONS A, B, and C must be fully
completed. Training for Private Providers
must be requested by DFCS staff to
ensure follow-through with the field
practice and approval process.
Information for course section number,
dates of class, and location can be
accessed by DFCS staff at:
www.gadfcs.org/transcript
DFCS FIELD PRACTICE MENTOR
INFORMATION
NAME:
Name of DFCS MENTOR FOR FIELD PRACTICE
COUNTY/
REGION:
TELEPHONE
#:
EMAIL:
In the spaces below, enter the information for course for which you would like to register.
COURSE
NUMBER
PE 529
Course Name
Section
Number
DATES OF CLASS
TRAINING SITE
LOCATION/CITY
FTM Training for Facilitators
Revised 05/13 – PE 529 FTM Training for Facilitators Only
Social Services Training Registration Form
FTM Training for Facilitators– Private Providers
Fax the completed form to: Fax: 404-413-1047
After your information has been entered into the registration system, you will receive a confirmation
letter via email.
Questions related to Family Team Meeting training registration?
Contact: Mr. Adriel Jones, ajones1957@gsu.edu
PE 529 FTM Training for Facilitators
Training for Private Providers must be requested by DFCS staff to ensure followthrough with the field practice and approval process. “FTM Training for Facilitators”
prepares participants to become approved facilitators for Family Team Meetings. The
classroom curriculum covers the basic what, why and when of Family Team Meetings.
Trainees are given a basic understanding of the skills required to facilitate an FTM, including
the principles of the change process, skills for building a trusting relationship, family dynamics,
and forming partnerships for positive change. In addition to classroom lectures and small
group activities, participants practice the skills needed for effective facilitation.
This course is primarily for individuals who will be facilitating and/or co-facilitating or
coordinating FTMs for DFCS. Participants should have participated in several FTMs before
attending classroom training, and must be assigned a field practice mentor by DFCS Regional
FTM Coordinator/Liaison. Following the 4-day classroom training, participants will work
with a mentor to complete a structured field practice. Upon completion of field practice, the
trainee will begin the approval process. The DFCS Regional FTM Coordinator/Liaison or
designee will observe and evaluate the trainee as he/she facilitates a Family Team Meeting.
The evaluator uses a standard observation tool for the evaluation, delivers feedback to the
trainee after the observation, and makes one of three recommendations:



Not to approve as a FTM facilitator
Approve as a FTM facilitator
Complete strategies to address needs and be observed and evaluated again before
approval as a facilitator
The signed evaluation tool is submitted to Betsy Lerner to file and track for the state office:
cblerner@dhr.state.ga.us . A statewide list is maintained of approved facilitators.
Revised 05/13 – PE 529 FTM Training for Facilitators Only