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Reporting Form
University Name:
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Semester:
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Input Data
Part 1 - Title IV-E SSW Programmatic
1.
Semester
Select record
Fall 2017
Fall 2018
Spring 2018
Spring 2019
Summer 2019
Fall 2020
Spring 2020
Fall 2021
2.
University
{{$agency_name}}
3.
Prepared by
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Part 2 - PROGRAM
4.
DFCS region(S) does your university most closely work with
Select Region
Region 1
Region 2
Region 3
Region 4
Region 5
Region 6
Region 7
Region 8
Region 9
Region 10
Region 11
Region 12
Region 13
Region 14
Regional Map
5.
Student Data Tracking Table
#
Total # of Applicants
# of SEED Applicants
Wait List
Withdrawal / Non-returning Students
Continuing Students
Graduating Students
Enrolled Parttime
Enrolled Fulltime
Enrolled DFCS
Enrolled non DFCS
Year 1 BSW Students
Year 2 BSW Students
1st Year MSW
2nd Year MSW
3rd Year MSW
Advanced Standing MSW
6.
Please list the child welfare classes offered this reporting period that meet the required curriculum standards of the DFCS Training Modules.
#
Title
Instructors Name
Number of IV-E Students Enrolled
Credit Hours
Course 1
Course 2
7.
Please provide information on the child welfare courses claimed as part of your reimbursement curriculum statistic for this reporting period.
#
Course Name/Section Title
Instructor
Credit Hours
Total # of Students Enrolled
# of Title IV-E Students Enrolled
Action
Course
Part 3 - RECRUITMENT & RETENTION
8.
Please describe any recruitment efforts/strategies implemented this reporting period at the university level.
9.
Please describe recruitment efforts/strategies implemented this reporting period targeted toward current DFCS employees.
10.
Did you conduct any Title IV-E informational/interest sessions this reporting period?
Yes
No
11.
If yes, how many Title IV-E informational/interest sessions did you conduct this semester?
Select Sessions
1
2
3
4
5
6
12.
Please provide some additional information about your informational sessions.
#
Date
Description
Number of people who attended
Location (on campus/ off campus)
Action
Session 1
Select
On
Off
Session 2
Select
On
Off
Session 3
Select
On
Off
Session 4
Select
On
Off
Session 5
Select
On
Off
Session 6
Select
On
Off
13.
Did you use social media to promote your Title IV-E project this reporting period?
Yes
No
14.
If No, please indicate whether or not you plan to incorporate social media and how in the future.
15.
If yes, how many Title IV-E informational/interest sessions did you conduct this semester?
Facebook
LinkedIn
Twitter
YouTube
Other
16.
Please indicate how much of a role social media played in the following efforts
#
A Considerable Amount
Quite a Bit
Some
None
New student recruitment
Communication with current students
Aid in retention efforts
Reach out to alumni
17.
Did your university/Title IV-E program assist DHS’ Office of Human Resource Management and Development (OHRMD) in hosting a career fair this semester?
Yes
No
Part 4 - CONFERENCES & TRAINING
18.
Were there any child welfare related conferences or trainings attended by Title IV-E Faculty,staff and participants?
Yes
No
19.
If Yes, please provide some additional information about the conference/training.
20.
Please list the number of people associated with your School of Social Work's Title IV-E program that attend the conference/training.
#
BSW students
MSW Students
IV-E Faculty/Staff
Number in attendance
21.
Did you attend a second conference or training this reporting period?
Yes
No
22.
If Yes, please provide some additional information about the second conference/training.
23.
Please list the number of people associated with your School of Social Work's Title IV-E program that attend the conference/training.
#
BSW students
MSW Students
IV-E Faculty/Staff
Number in attendance
24.
Did you attend a third conference or training this reporting period?
Yes
No
25.
If Yes, please provide some additional information about the second conference/training.
26.
Please list the number of people associated with your School of Social Work's Title IV-E program that attend the conference/training.
#
BSW students
MSW Students
IV-E Faculty/Staff
Number in attendance