Western Wisconsin Partnership On-Line Registration Form

Please complete all information requested. If a field is left blank, your registration will not be complete. For more information on the individual workshops, follow this link to the workshop page of our site.

The cost for each workshop for Partnership members is usually $15.00 per day (unless otherwise noted). Others may register for these workshops on a space available basis, but must pay the full workshop fee. For more information, contact the Western Wisconsin Partnership Office at 715-425-0612, or email Mary Lou Bean, Senior Outreach Specialist.

Workshop Title
Date(s) of Workshop
Location of Workshop
Time of Workshop
Name
Title
Organization
Phone Number
Street Address
City State Zip
Email
Supervisor's Name
Supervisor's Email
Do you have any job responsibilities for providing ongoing case management for CPS/JJ cases including coverage for other staff? Yes No
Do you have any job responsibilities for working with children and/or youth placed in out-of-home care and/or for licensing or supporting foster parents? Yes No
Do you supervise any of the above functions? Yes No
Supervisory and/or Practice Areas (Check all that apply):
CPS Juvenile Justice
Foster Care Coordinator Foster Parent
Special Needs Adoption Other: Please specify

If you are completing this form for a foster/adoptive parent, please include their email address in the email space above. This will enable us to contact them and send their confirmation letter to them personally.

Do you have any special dietary needs? If so, please explain.

Waiver

I understand that I must send payment in full for the workshop(s) for which I have registered. I also understand that workshops are filled on a first-come first-serve basis. You will be notified by email within five working days if the workshop is full and your registration was not accepted. Otherwise, you will get a confirmation email within two weeks of the workshop. You must check this box, stating that you understand the previous statements, before your registration will be complete.

This form is for use by Partnership members and invited guests only.


Western Wisconsin Partnership
Social Work Program
University of Wisconsin-River Falls
410 South Third Street , B0026 WEB
River Falls WI 54022
Phone: (715)425-0612
Fax: (715)425-3800
Email: mary.lou.bean@uwrf.edu
Website: www.uwrf.edu/wwpartnership