ࡱ> O fbjbj >(wewen!  %%MMMaaa8=a2D9F*#*#*#CCCCCCC$FzICM%6"*#%%C%%yC(((%v%(MC(%C((=T?eLh/&M>CD02De>\2J5'2J0?2JM?*#v#T(#D8$*#*#*#CC(*#*#*#2D%%%%2J*#*#*#*#*#*#*#*#*# :  EMBED MSPhotoEd.3    To: Potential Title IV-E Stipend Recipient From: Mrs. Andrea Black| Title IV-E Coordinator Subject: Stipend Application Instructions Message: Thank you for your interest in Title IV-E. Please follow the instructions closely and read thoroughly before completing. First, please read the contract through to be sure this is for you (keep this copy for yourself). Secondly, complete the application in its entirety and return. Thirdly, select 3 dependable references who you trust to return before the deadline date. Be sure to be courteous and place a stamp on the envelope. Fourth, complete and sign the FERPA Student Consent Form, and Physical Requirement & Condition Form and return. Good luck! Dear Applicant: Thank you for your interest in the Title IV-E Child Welfare Stipend. The Department of Children & Family Services (DCFS) is seeking competent well trained social workers prepared for a career in Child Welfare with a constant betterment of services and protection of children from child maltreatment. As a stipend recipient, you are obligated to complete a block placement internship (during the semester that you graduate) with DCFS and work for DCFS for one year after graduation upon obtaining your Social Work Licenses. If you feel that you are right for a career in child welfare, please view the DCFS Realistic Job Preview at  HYPERLINK "http://www.dcfs.la.gov" www.dcfs.la.gov, click on Child Welfare (left side), scroll down to Child Welfare Recruitment Video: Is Child Welfare The Job For You? (mid-way the page) and click and view. The video is 16 minutes long and paints a clear picture of the commitment, challenges and rewards of a career in public child welfare. Or you may pull it up on YouTube. After viewing the video, please complete the application & all necessary forms, follow directions and respond to the questions listed below. Please type you answers on a separate sheet of paper: How did the video affect/ impact your thoughts about child welfare? Please provide specific examples. What aspects of child welfare are most attractive to you? Which parts of the job featured in the video would be the most difficult for you? Your application, the responses to the Realistic Job Preview, your reference letters, consent & Physical Requirement Form should be submitted to my office (Andrea Black) 700 University Ave., 234 Strauss Hall by February 28, 2021. Applications will be reviewed and scheduled for an interview. Please call 318-342-1457 with any questions. Respectfully, Andrea Black Title IV-E Coordinator UNIVERSITY OF LOUISIANA AT MONROE Title IV-E BSW Child Welfare Training Project Academic Year 2020-2021 INSTRUCTIONS FOR APPLICATION Students! Note these are updated criteria, which vary somewhat from those listed in the last edition of the Ӱ Social Work Program Student Handbook. Applications are available from the Social Work Program office. Students are advised to read the description of the program and the sample Ӱ & DCFS Student Contract before applying. This is a competition with a $7,500.00 stipend award that requires state employment upon graduation. If you are selected, you will be required to sign and abide by the student contract under penalty of repayment of any stipend received to DCFS. You are obligated to fulfill a one-year employment requirement. Students must complete the application form and submit to the Ӱ Social Work Office, Mrs. Andrea Black, no later than mid March. Additional paper must be used to answer open-ended questions on the application form. Students must contact their references and request permission before delivering the reference form in the application packet. Advise the reference person of the mid March deadline to submit the reference letter to the Title IV-E Project Coordinator at Ӱ. If these are not received, your application will be considered incomplete and will not be included in the competition. Be sure to stamp the enclosed self-addressed envelopes as a courtesy to your reference person. After applications are received and eligibility verified, student applicants will be contacted for a selection screening process which will be conducted at the DCFS Ouachita Parish Office, 24 Accent Drive, Ste. 106 in Monroe or via zoom. Students will receive a letter from the Title IV-E Project Coordinator at Ӱ with an appointment date. Interviews will be scheduled tentatively during the months of March and April, depending on the number of applicants. If selected, students will be required to complete their field placement in one of the 11 parish offices within the Region IX DCFS area, indicated on the application form. All efforts are made to locate selected students in a parish office that is as convenient to the student as possible, but it is possible that selected students may be required to drive to an outlying rural parish. This is dependent on the availability of DCFS staff available for student supervision. ELIGIBILITY REQUIREMENTS: GPA of 3.0 in social work courses for the major (Overall 2.7 GPA) Eligible for field placement in the Spring Completed SOCW 4008: Child Abuse & Neglect before field placement semester Own Transportation, Current Drivers License & Automobile Insurance (must be submitted with application) Clear Criminal History Record, Driving Record, and Drug Screen (with Drug Screens randomly assigned after selection) and current Drivers Licenses. Selected students who are found to have falsified this information on the application will be immediately dismissed from Title IV-E participation. Completed at least 6 credit hours before semester of field placement from the following courses: SOCW 3020: Case Management SOCW 4001: Child in the Community SOCW 4003: Social Work with Family Violence SOCW 4005: Differential Diagnosis SOCW 4010: Human Service PSYCH 2003: Child Psychology PSYCH 2005: Adolescent Psychology CJUS 3008: Substance Abuse CJUS 4015: Juvenile Delinquency SOCL 4019: The Family Willingness to travel by air or automobile to out-of-state and in-state conferences Willingness to complete one week DCFS training during field Willingness to complete Driver Safety Course through Ӱ Environmental Health & Safety Dept. Must have own vehicle, drivers license & current automobile insurance at the time of application Must complete Physical Requirements & Conditions Form University of Ӱ @ Monroe Child Welfare Stipend Application Print or type all parts of the following application (blue or black ink only). Part 1: Identifying Information Name _______________________________ E-mail _____________________ SS Number __________________________ DOB: ______________________ Address: Home ________________________________________________________ ________________________________________________________ School Address (if different from above) _____________________________________ ________________________________________________________ Telephone: Home ________________________ Work _________________________ Cell __________________________ Are you a citizen of the United States? ___ yes ___ no  Part 2: DCFS Requirements Do you have your own transportation? ___ yes ___ no Are there any restrictions on your drivers license? ___yes ___no List dates of any auto accidents and tickets when you were driving during the past five years. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Do you have any relatives working for DCFS? If yes, in what office and what is their relationship to you? __________________________________________________________________________________________________________________________________________________________ Have you ever been employed by DCFS? If yes, in what office? _________________________ Dates of employment ___________________________________________________________ Have you completed the child welfare courses which are required for this internship? ___ yes ___ no If not, please indicate below, when you expect to take the remaining courses. _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Part 3: Contractual Requirements 1. IV-E interns are required to complete five or more days of DCFS training, the location of which may require you to travel and/or stay overnight. Your expenses will be covered but you may have to pay some expenses and wait for reimbursement. Are you willing to accept these conditions? ___ Yes ___ No 2. IV-E interns must complete a criminal history check. (If you have ever been convicted of a felony, please attach a statement of explanation.) There are some felony convictions which make a person ineligible for employment by DCFS. If such a conviction is found by the criminal history check, you may be dismissed from participating in Title IV-E and required to repay any stipend award which has been received. Are you willing to accept these conditions? ___ Yes ___ No 3. IV-E interns must have a random drug screen. If the drug screen indicates current use of illegal drugs, you may be dismissed from participating in Title IV-E and required to repay any stipend award which has been received. Are you willing to accept these conditions? ___ Yes ___ No 4. IV-E interns who successfully complete the internship are obligated to work for DCFS for a period of one year if offered employment within 60 days after graduation. If employment is offered and refused within the 60 day time frame, repayment of the stipend is required. Are you willing to accept these conditions? ___ Yes ___ No 5. If you selected as an IV-E Intern, your placement may require that you commute, at your own expense, to an office which is not in your parish of residence but which is within reasonable drive distance. Are you willing to do this? ___ Yes ___ No 6. DCFS requires that employees be available to work at night when needed, have reliable transportation, and have no health conditions which interfere with job performance. Since the purpose of the stipend is to recruit potential employees, if you cannot meet these conditions for employment, the stipend offer will be withdrawn. If any other information is learned which makes you ineligible for employment by DCFS, the stipend offer will be withdrawn. Do you understand this? ___ Yes ___ No 7. Please list below your preferences for placement by parish: 1st __________________ 2nd __________________ 3rd __________________ Part 4: Background, Experiences, and Motivation (Type questions and answers on a separate sheet of paper.) 1. What paid or volunteer experience have you had in work with children and/or families? 2. Briefly describe your understanding of and/or experience with the child welfare system. 3. Briefly describe your motivation/goals related to working in this field of practice. 4. Many clients who utilize the services of DCFS programs are affected by poverty, mental illness, mental retardation, substance abuse, etc. In what ways are you prepared to interact with these factors? 5. What academic, professional, and personal strengths will you bring to the field placement? 6. Briefly describe your beliefs as to what are the most powerful forces in a childs life. Part 5: References List three references below. Ask each to complete the reference form and return it to the social work department before mid-March. Provide each reference with a stamped and addressed envelope. 1. ___________________________________________ 2. ___________________________________________ 3. ___________________________________________ Please return all documents to: University of Ӱ @ Monroe Andrea Black| Project Director Social Work Program Title IV-E Child Welfare 700 University Ave., 234 Strauss Hall Monroe, LA 71209-6236 Phone: (318) 342-1457 Email:  HYPERLINK "mailto:asavage@ulm.edu" asavage@ulm.edu Indicate if you are currently enrolled in or have completed any of the following courses with a grade of A or B received: SOCW 4008 and at least two additional courses from the following list must be completed. Course Semester EnrolledGrade Received (write pending if you are currently enrolled or will be enrolled in)SOCW 4008 Child Abuse & NeglectSOCW 4001 Child in the CommunitySOCW 4003 Family ViolenceSOCW 4005 Differential DiagnosisSOCW 3020 Case ManagementSOCW 4010 Human ServicesPSYC 2003: Child PsychologyPSYC 2005: Adolescent PsychologyCJUS 3008: Substance Abuse CJUS 4015: Juvenile DelinquencySOCL 4019 The FamilySOCL 2003 Social Problems  SEQ CHAPTER \h \r 1UNIVERSITY OF LOUISIANA @ MONROE DEPARTMENT OF CHILDREN & FAMILY SERVICES STUDENT CHILD WELFARE STIPEND REFERENCE FORM The student applicant is responsible for requesting their reference to complete this form and return it back by the requested date mid-March to: Ӱ SOCW Title IV-E Program, Attn: Andrea Black, 700 University Ave., 234 Strauss Hall, Monroe, LA 71209-6236. Applicants Name ___________________________________________________________________ Reference Name: _______________________________________________________________________ Address: ______________________________________________________________________________ ______________________________________________________________________________ Telephone: Work __________________ Fax ____________________ E-Mail_________________________ In what capacity and how long have you known the applicant? ______________________________________________________________________________________ Directions: Please rate the applicant's personal and professional characteristics below:  ExcellentAbove Average AverageBelow Average PoorUnable to EvaluateMotivation to LearnPerseverance with tasks and assignmentsDemonstrates initiativeConscientiousnessDemonstrate empathy and acceptance of multi-problem familiesVerbal communication skillsWritten communication skillsWorks effectively with otherWorks effectively with diverse populationsInterest in working with families and childrenAbility to accept supervisionDemonstrate professionalism/ethics Please add any further comments about the suitability of the applicant for working with the family and child in the areas of child protection, foster care and adoption. What is your overall recommendation of the applicant? Please check one of the following: _____ Not Recommended _____ Recommended with Reservations _____ Recommended without Reservations _____ Highly Recommended ___________________________________ ________________________ Signature Date FERPA STUDENT CONSENT FORM FOR ACCESS TO EDUCATION RECORDS    Agreement between University of Ӱ @ Monroe , The State of Ӱ Department of Children and Family Services, and Student: _______________________________ BSW Child Welfare Stipend Award The following agreement is hereby entered into between Diamond Williams (hereinafter stipend recipient) (University of Ӱ) (hereinafter Ӱ), and the Ӱ Department of Children and Family Services, (hereinafter DCFS). Social Security # of Stipend Recipient: 1. Stipend Recipient Obligations In consideration of selection by (Ӱ) and DCFS to receive a child welfare stipend, the stipend recipient agrees to the following: A. To undertake and maintain satisfactory academic progress in the necessary courses to receive a Bachelor of Social Work degree from (Ӱ), said courses to include specified child welfare courses as designated by the School of Social Work. Additionally, stipend recipient will complete and pass the comprehensive exam. B. To successfully complete the internship courses required by the Bachelor of Social Work (BSW) degree program in a DCFS field office working in a direct service placement unless stipend recipient have three years of experience with DCFS, in which case an administrative or indirect service placement with DCFS may be approved. The internships shall be completed during the senior year of the Bachelor of Social Work degree program. C. If the stipend recipients education is discontinued prior to attainment of the Bachelor of Social Work degree, or the stipend recipient fails to attain the Bachelor of Social Work degree, or the stipend recipient does not remain in good standing as defined by (Ӱ) as required herein, then the stipend recipient shall reimburse DCFS the total amount of the stipend received by the stipend recipient under this agreement. Payment shall be made as provided for in paragraph 3 D. herein. D. To complete and submit a Civil Service application for employment with DCFS within 48 hours of notice from DCFS Child Welfare Programs that there is a position available for employment. E. If the stipend recipient fails to apply for employment with DCFS within the timeframe set in paragraph 1 D. herein, the stipend recipient shall reimburse DCFS the total stipend received by the stipend recipient under this agreement. Payment shall be made as provided for in paragraph 3D herein. F. To apply for and obtain the social work license. If the stipend recipient fails to apply for and obtain Licensure through the Ӱ Board of Social Work Examiners (LABSWE) within one month following the recipients graduation date, the stipend recipient shall reimburse DCFS the total stipend received by the stipend recipient under this agreement. G. If the stipend recipient refuses to immediately accept an offer of employment from DCFS, the stipend recipient shall reimburse DCFS the total stipend received by the stipend recipient under this agreement. Payment shall be made as provided for in paragraph 3 D. herein H. To work for DCFS in a position and location as assigned by DCFS for a minimum of one year of continuous and satisfactory full-time employment immediately following graduation. I. If the stipend recipient fails to work for DCFS completing the required year (s) of employment with DCFS immediately following graduation, the stipend recipient shall reimburse DCFS the total stipend received on a pro-rata basis of qualifying employment completed. Payment shall be made as provided for in paragraph 3 D herein. J. To participate in all evaluations of this program as requested by (Ӱ) School of Social Work, the Ӱ Child Welfare Training Academy/University Workforce Alliance, and/or DCFS during and following the stipend period. K. To submit to complete a random drug test, finger printing for a criminal records check, a motor vehicle clearance, a state central registry of abuse or neglect clearance, and any other pre-requisites for employment with DCFS and be in satisfactory compliance with policy and procedure. L. To acquire and maintain status as a United States citizen. M. To immediately notify (Ӱ) and DCFS of any academic problems, convictions, entry of name on the state central registry of abuse or neglect findings, any changes in ability to carry out child welfare caseworker duties, or changes in name, address, or phone number until such time as employment obligation has been fulfilled or any amount owed under this agreement is paid in full or otherwise retired. N. To adhere to the National Association of Social Workers (NASW) Code of Ethics and to follow all State and Federal laws. 2. (Ӱ) and DCFS Obligations In consideration of the above (Ӱ) and DCFS agree to the following: A. To provide to the stipend recipient a stipend in the amount of six thousand and five hundred and no/100 ($7,500.00) dollars through (Ӱ) for the senior year of the Bachelor of Social Work degree program. The disbursement will be made in accordance with the universitys policies. B. To offer employment with DCFS for the stipend recipient, subject to Civil Service rules, within two (2) months of the stipend recipients approval for licensure by the Ӱ Board of Social Worker Examiners (LABSWE), unless DCFS is precluded from providing such employment, through no fault of the stipend recipient, because of circumstances beyond DCFSs control, e.g. Civil Service system requirements, legislative budget cuts, position freezes, etc., in which case stipend recipient is relieved of the obligation to work for DCFS for the one year period immediately following graduation and the stipend recipient will not be required to reimburse DCFS for amounts received by the stipend recipient under this agreement. 3. General Provisions A. This agreement shall commence upon disbursement of any portion of the stipend to or on behalf of the stipend recipient and shall terminate upon successful completion of the required employment or reimbursement by the stipend recipient. This agreement may be terminated at an earlier date if mutually agreed upon in writing or upon thirty (30) days written notification to DCFS and (Ӱ) by the stipend recipient, provided that the stipend recipient reimburses DCFS for all amounts due under this agreement. This agreement is made with the understanding that it shall be interpreted and enforceable under the law of the State of Ӱ within the jurisdiction and venue of the 19th Judicial District Court, Parish of East Baton Rouge, State of Ӱ. B. Any failure of DCFS at any time, or from time to time, to enforce or require the strict keeping and performance by the stipend recipient of any of the terms or conditions of this agreement shall not constitute a waiver by DCFS of any such terms or conditions and shall not affect or impair such terms or conditions in any way, or the right of DCFS at any time to avail itself of such remedies as it may have or any such breach or breaches of such terms or conditions. C. If it is necessary for DCFS to commence legal action against the stipend recipient to enforce the terms of this agreement, stipend recipient agrees to pay the total accrued amount still owed plus interest, reasonable attorneys fees and all court costs. D. Any reimbursement required by this agreement to be made by the stipend recipient to DCFS shall be paid within 60 days of the event which triggers the reimbursement, or, at DCFSs option upon written request by the stipend recipient a reimbursement plan may be established to repay the principal amount due, together with interest thereon, at the rate of 5% per annum for a term not to exceed twenty-four (24) months beginning no later than 60 days of the event that triggers the reimbursement. E. If the stipend recipient is subject to reimbursement and fails to execute a written reimbursement plan agreement, the total stipend amount will become immediately due and payable. F. If the stipend recipient enters into a reimbursement plan agreement and fails, without written approval of DCFS, to make any scheduled monthly payment according to the reimbursement plan agreement, the total amount still owed shall, at the option of DCFS, become immediately due and payable. G. At the option of DCFS upon written request by the stipend recipient a Hardship Postponement to the work obligation requirement or the reimbursement plan may be granted. The Hardship Postponement would allow, in certain limited situations a postponement of the work obligation requirement or reimbursement obligation for up to one year to be granted in six month increments. Hardship is defined as: 1) a critical illness or injury of stipend recipient, of his or her spouse, or of his or her legal child; 2) which occurs during the year of the IV-E stipend award; and 3) prevents the stipend recipient from working due to his/her own critical illness or injury or caring for a spouse, or child with a critical illness or injury. The request for a Hardship Postponement must include in writing an explanation of the following: 1) medical documentation verifying the necessity for dropping from a university social work program; 2) the date the condition commenced; 3) probable duration and treatment requirements of the condition; 4) requirement for and duration of any overnight stay in a hospital, hospice, or residential medical care facility; 5) explanation of the impact on the stipend recipients family which was created by the critical illness or injury. H. If the stipend recipients failure to complete the one year of employment with DCFS upon graduation is due to death, permanent disability, or other emergent circumstances causing a permanent condition which would prohibit the stipend recipient from the employment determined by DCFS to be valid, the stipend recipient will be relieved of this obligation to work for DCFS for the one year period immediately following graduation and the stipend recipient will not be required to reimburse DCFS for amounts received by the stipend recipient under this agreement. I. If a student has a criminal or a motor vehicle offense conviction or is convicted of such an crime/offense during his/her education program that would preclude employment with the DCFS, the student shall not be employed by the DCFS, will be dropped from the stipend program and shall repay the stipend in accordance with Section 3 D. above. J. If a students name is on the state central registry of abuse or neglect findings, and such entry would preclude employment with the DCFS, the student shall not be employed by the DCFS, will be dropped from the stipend program and shall repay the stipend in accordance with Section 3 D. above. K. If a student fails to meet any of the qualifications for employment, such as failure to obtain a social work license, student shall not be employed with DCFS and shall repay the stipend and shall repay the stipend in accordance with Section 3 D. above. THIS AGREEMENT CONTAINS OR HAS ATTACHED HERETO ALL OF THE TERMS AND CONDITIONS AGREED UPON BY THE PARTIES HEREIN. IN WITNESS THEREOF, THIS AGREEMENT IS SIGNED AND ENTERED INTO ON THE DATE ENTERED BELOW. STIPEND RECIPIENT University of Ӱ @ Monroe LA DEPARTMENT OF CHILDREN SCHOOL OF SOCIAL WORK AND FAMILY SERVICES NAME OF RECIPIENT: NAME OF DEAN or DEPT CHAIR: RHENDA HODNETT, Ph.D., LCSW ASSISTANT SECRETARY CHILD WELFARE PROGRAMS: _______________ ________________ _____________ ___________________________ ___________________________ Signature Date Signature Date Signature Date I, ___________________________________, spouse of _________________________________(stipend recipient) hereby acknowledge this agreement as an obligation of our community estate, and ratify it and all its terms and conditions. NAME OF STIPEND RECIPIENTS SPOUSE: _____________________________________(Print) _______________________________________ Signature Date The Department of Children and Family Services is an Equal Opportunity Employer. The Department does not discriminate based on race, color, religion, sex, age, national origin, handicapping conditions, veteran status or any other non-merit factor     PAGE 7 Social Work Department Title IVE- Strauss 234 700 University Avenue Monroe, LA 71209-6236 Phone: (318) 342-1457 Fax: (318) 342-3239 UNIVERSITY OF LOUISIANA AT MONROE MEMORANDUM Classification BSW Semester of internship Spring 20_____ Semester of graduation Spring 20_____ Overall GPA _____ (2.7 or better required)| Social Work GPA _____ (3.0 or better required) __________________________ __________________ _______________ Name of Student Student ID # Date The Federal Educational Rights and Privacy Act of 1974 (FERPA) affords certain rights to students concerning the privacy of, and access to, their education records. Third parties under FERPA cannot access your records without your written permission. However, students may choose to complete this form to allow release of their education records to specified third parties. Even with this consent form, information cannot be given to a third party via the telephone or e-mail. For additional information, visit the NSU FERPA information page at  HYPERLINK "http://www.ulm.edu/registrar/documents/ferpa" www.ulm.edu/registrar/documents/ferpa or the U.S. Department of Educations website at  HYPERLINK "http://www.ed.gov/policy/gen/guid/fpco/ferpa/index.html" www.ed.gov/policy/gen/guid/fpco/ferpa/index.html. By completing, signing, and dating this consent form, I am giving faculty of the University of Ӱ @ Monroe Department of Social Work my permission to discuss with and or release to representatives of the Department of Children & Family Services the following information: My academic record including grades, GPA, academic status, and transcript. This information is to be used only in determination of IV-E stipend awards. I understand that (1) I have the right not to consent to the release of my education records, (2) I have the right to inspect any written records released pursuant to this consent, and (3) I have the right to revoke this consent at any time by completing the section below. _________________________________ _______________________ Students Signature Date Please sign and date below ONLY if you are revoking this consent. 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