Child Welfare Virtual Conference Registration Form

Child Welfare Virtual Conference: [Title]: Registration Form

PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)   The purpose of this information collection is to gather feedback on capacity building products and services to better meet the needs of child welfare professionals. Public reporting burden for this collection of information is estimated to average 2 minutes per respondent, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This is a voluntary collection of information. An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information subject to the requirements of the Paperwork Reduction Act of 1995, unless it displays a currently valid OMB control number. The control number for this project is 0970-0501. The control number expires on xx/xx/xxxx. If you have any comments on this collection of information, please contact Roshanda Shoulders, ACF, Administration on Children, Youth and Families (ACYF) by e-mail at Roshanda.Shoulders@acf.hhs.gov.

Instructions for Participants

Join the Children’s Bureau and Child Welfare Capacity Building Center for States on <insert date and time> for the Child Welfare Virtual Expo.

The Virtual Expo provides child welfare agencies, courts, and tribes with information, resources, and skill-building activities to strengthen child welfare assessment and decision-making. This year’s Virtual Expo has separate tracks tailored for frontline workers and administrators/managers.

Join us online on <insert date> to:

• Meet and hear from experts and peers on best practices and tools for assessment and decision-making

• Build your knowledge related to:

• Using assessment data at the systems level to improve safety, permanency, and well-being (Administrative/Management Track)

• Working with families in child welfare affected by co-occurring issues (Administrative/Management Track)

• Applying safety decision-making as a means to prevent repeat maltreatment (Frontline Workers Track)

• Moving the dial on comprehensive assessment of parents (Frontline Workers Track)

• Learn to transfer session knowledge and concepts into practice improvements

Click here <hyperlink to conference webpage> to access the Child Welfare Virtual Expo website for more information.

Five Things to Do at the Expo

The Child Welfare Virtual Expo will enable you to build your knowledge and network from the comfort and convenience of your own office. Use your computer, tablet, or smart phone to:

1. Participate in six video-streamed sessions featuring national subject matter experts, child welfare agency representatives, partners, parents, and youth

2. Chat and exchange ideas with your peers across the country

3. Visit exhibit booths to connect and network with subject matter experts and State leaders

4. Participate in games through the interactive virtual environment for fun a way to learn

5. Download relevant resources and tools to use in your everyday work

Register for the Virtual Expo

Space at the Child Welfare Virtual Expo is limited. Please register to reserve your virtual seat. Participation as a group within your agency/organization is encouraged.

Having trouble registering? Email capacityinfo@icfi.com for assistance.

Registration Form

#	Registration Field	Field Type
1	First Name*	Text
2	Last Name*	Text
3	Email Address*	Text
4	State*	Picklist (All States, U.S. territories)
5	Time Zone*	Picklist
6	How did you hear about the conference?	Capacity Building Collaborative webpage  Center’s Liaison  Listserv  Colleague   Hard-copy publication  Search engine (e.g., Google, Yahoo)  Social media (e.g., Facebook, Twitter)  Link from another webpage   Other (please specify):__________
7	Did you participate in last year’s Virtual Expo (July 2016)?	Y/N
8	Employer/Organization*	Text
9	Which best describes your employer/organization? (Select one)*	State Child Welfare Agency County Child Welfare Agency Territorial Child Welfare Agency Tribal Child Welfare Agency State or County Court/Legal System Tribal Court/Legal System Private or Community-based Child Welfare Agency Local Government/Tribal Council Law Enforcement Organization Primary Care/Health Care Services Provider Behavioral/Mental Health Services Provider Substance Abuse Services Provider Domestic Violence Services Provider Juvenile Justice Organization Primary/Secondary Education College/University Technical Assistance Provider Federal Government Other Not Applicable
10	Primary Role*	State/County/Territory/Tribal Agency Agency Director/Deputy Director Program/Middle Manager Supervisor Caseworker/Direct Practice Worker/Frontline staff Parent Partner State/County/Territory/Tribal Court CIP or TCIP Director/Coordinator CIP or TCIP Staff Judge Attorney for Child Welfare Agency Attorney for Parent Attorney for Child Attorney Guardian Ad Litem Court Administrative Officer Court/Attorney Data Manager/IT Staff Court Appointed Special Advocate/Non-attorney GAL/Advocate Court Case Worker/Social Worker School/University Dean/Director/Administrator Teaching Faculty Training Academy Leadership/Staff Research Faculty/Staff (non-teaching role) Student Other Technical Assistance Provider Other Not Applicable
11	Which of the following best describes your primary work responsibilities? (Select one)*	Workforce Development/Training Continuous Quality Improvement/ Evaluation Information Technology/SACWIS/Data Systems Indian Child Welfare Act Primary or Secondary Prevention Child Protective Services In-home Services/Promoting Safe and Stable Families Foster Care/Placement/ Licensing/Reunification Adoption/Guardianship Youth in Transition/Chafee/ Independent Living Programs Other Not Applicable
12	How many years of experience do you have working in child welfare? (Select one)*	Less than 1 year 1–5 years of service 6–10 years of service 11–15 years of service 16+ years of service Not Applicable
13	How do you plan on participating in the Virtual Expo?*	Computer (PC) Computer (Mac) Tablet Smartphone Combination of technologies (computer, tablet, and/or smartphone)
14	If you plan on participating in a group (sharing one registration), how many people will be in your group?*	Text
15	Which track do you plan on participating in?(You will be able to change your track later if you want)*	Frontline Administrative/Management
16	Why are you attending the conference?*	Text
17	We are looking for volunteers to participate in a virtual 1.5 hour focus group or a 30-minute individual telephone interview, 1-2 weeks after the Virtual Expo. The purpose of these focus groups and interviews are to get more detailed feedback about your experience with the Virtual Expo. Can we contact you about your availability?*	Y/N

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