Foster Parent Foundation Training Registration Form

www.uwrf.edu > Western Wisconsin Partnership > Foster Parent Foundation Training Registration Form

First Name*:

Last Name*:

E-mail*:

Work Phone*:

Cell Phone:

Are you a Foster Parent?:

yes

no

If you are not a foster parent, what is your title?:

Agency Information

Agency (for billing purposes)*:

County*:

Agency Address:

Agency City, State, Zip:

Foster Care Coordinator Name*:

Foster Care Coordinators E-mail:

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Menomonie, EconoLodge & Suites, 1815 North Broadway:

May 21 - module 9 - 5:30-8:30

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La Crosse County DHS, 300 4th St. North, La Crosse:

May 15 - module 8 - 6-9 pm

May 19 - modules 4A & 4B - 9 am to 3:30 pm

May 23 - module 3 - 6-9 pm

May 24 - module 9 - 6-9 pm

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Northcentral Technical College, Wausau:

May 30-Module 1 - 5:30 to 8:30

May 31-Module 7 - 5:30 to 8:30

June 4-Module 6 - 5:30 to 8:30

June 5-Module 2 - 5:30 to 8:30

June 7-Module 5 - 5:30 to 8:30

June 12-Module 8 - 5:30 to 8:30

June 20-Module 4A - 5:30 to 8:30

June 21-Module 4B - 5:30 to 8:30

June 25-Module 3 - 5:30 to 8:30

June 26-Module 9 - 5:30 to 8:30

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