Proposal Form

University Name:

Academic Year:

Prepared by:

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Input Data

Part 1 - School Information

1. College/University

Address

2. School Title IV-E Contact Person

Address

3. Direct Telephone

Email Address

4. Principle Investigator

5. Institutional Financial Officer

Address

6. Direct Telephone

7. Email Address

Part 2 - Title IV-E Program General Description

8. Indicate Academic Year

9. Academic Calendar
Please check all boxes for which IV-E Program will be active

Fall
Spring
Summer

10. General Description

	Full Time	Part Time	DFCS Seed Students
# of BSW
# Of MSW

11. Child Welfare Curriculum Requirements:
A stipulation for participation in the Title IV-E program requires each school to have a minimum of two child welfares courses in their curriculum. The courses must include information that aligns with the current DFCS New Case Manager Training. The case manager training is a series of learning modules that support new workers in the field of child welfare. Specific topics include an introduction to child welfare services, family assessment, child maltreatment, effect of trauma on child development, child placement and the legal system, process for child welfare reviews and performance improvement plans.

	List the two child welfare course titles that satisfy the above description	Course Number
1
2

Part 3 - School Proposal Narrative

12. School of Social Work Program Overview
Describe the emphasis of the Title IV-E program at your institution (generalist, clinical, administrative; undergraduate, graduate, both, etc.). Include in your program description how the Title IV-E will meet DFCS regional hiring needs in your locality.

13. Curriculum Competency Description

Name Of Course	Competency Description	Provide Course Title and Numbers, and/ or Brief program Activity Description	Action
Complex Cognitive Skills	Course/program activities that promote reflective thought, critical thinking, cultural competency, quantitative reasoning and intellectual flexibility.
Ethical Practice in Child Walfare	Course/program activities that promote ethical standards and values for public child welfare practice.
Knowledge Acquisition	Course/program activities that promote student mastery of child welfare knowledge on principles, policies, practice and procedures as taught in the classroom setting.
Practical Competence in Public Child Welfare institutions	Program activities that promote selfawareness, Self-reflection, and understanding of institutional power and authority
Academic Achievement	Program activities that assist students'to maintain required minimum grades for each course in the curriculum.
Persistence/ Retention	Program activities that support and guidance to students from enrollment to successful graduation.
Incorporation of DFCS New Worker Training Materials	Describe how the new worker training matetials will be used to provide enhanced learning for Title IV-E Students.

14. Field Placement

	Competency Description	Provide Course Title and Numbers, and/ or Brief Program Activity Description	Action
Knowledge Acquisition	Course/Program activities that promote student mastery of child welfare knowledge on principles, policies, policies, practice and procedures as taught in the field setting.
Field Practice Competence	Courses/activities that integrate curriculum knowledge with practice application.
Additional Experiences	Describe other unique experiences, outside of the classroom, that will be offered to Title IV-E students (e.g, individual/group coaching, mentoring, tutoring, field student chat rooms, etc.)

Part 4 - Recruitment & Retention Plan

15. Provide a detailed narrative of your student recruitment plan for the applied for contract year. *Note the plan must specifically outline both general student applicant recruitment and SEED applicant recruitment efforts.

16. Provide a detailed narrative of your student retention plan for the applied for contract year. *Note the plan may specifically outline both general student applicant retension activities and SEED applicant retension efforts.

17. Describe other planned training opportunities for Title IV-E students, including attendance at state or national professional meeting, special mandatory child welfare traing semminars, program sponsored student workshops or conferences, includind provisions for SEED students.

Part 5 - Budget

Test Title IV-E Social Work Stipend Program Budget

1. Administrative Staff Costs
Administrative Staff Name	Base Salary	% of Time	Dedicated Annual Budget to IV-E Program	%Title IV-E Material curriculum statistic	Eligibility Rate	Reportable Costs	Federal Share	Federal Reimbursement	University Reimbursement Required?	Action
Administrative Staff Name	Base Salary	% of Time	Dedicated Annual Budget to IV-E Program			Reportable Costs		Federal Reimbursement	University Reimbursement Required?	Action