Washington County Forms

2. TRAINING REFLECTION
   To receive credit for materials used which are not part of a formal workshop in which participants are supplied with a certificate to verify their attendance, you must complete the following questionnaire. Present this questionnaire to your licensor for approval towards the training credit. Which materials qualify for credit and the number of credits accepted will be determined by your licensor. If you have questions whether an activity, book, video, or other material will be accepted, please contact your licensor to discuss it.
4. Title of Material:*
6. Type of Material:

   1. Book
   2. Lecture
   3. Video
8. Other:
10. Length of Material: *
    Video (Minutes); Book (Number of pages); Lecture (Minutes)
12. Please provide a brief summary of the content of this material:*
14. How do you feel you will be able to apply the information you learned to working with children in your care?*
16. What is your name?*
18. Please select your foster care licensor.*
    -- Select One --I don't know who my licensor itEmmy XiongMichelle McIntoshSarah YangTheresa Allen
Leave This Blank:


20. 1. Receive an email copy of this form.
21. Email address

    This field is not part of the form submission.

22. Submit Submit and Print

* indicates a required field