FSS Professional Competencies Training Registration Form This form registers you to participate in TVC and NAMI-TN’s FSS Professional Competency Training, which is required for certification by TDMHSAS as a Family Support Specialist. The course is provided from 8:30 AM-4:30 PM with an hour lunch break on three consecutive days and includes the FSS Professional Competencies manual, practice tests, and final competency test/trainer evaluation. Trainings are provided in each grand region throughout the year. Please fill out the form below and return with payment to: Wendy Sullivan, FSS Training Coordinator Tennessee Voices for Children, 701 Bradford Avenue, Nashville, TN 37204 Phone: 615/269-7751 ext. 140 Fax: 615/269-8914 Name ________________________________________ Org. (if applicable) ______________________________ Address _______________________________________ City ___________________ Zip Code ______________ Phone Number _________________________ Email _________________________________________________ Preferred Contact?
Phone
Email
Registering for ____ December 9-11 2015, Nashville
Have you completed the pre-requisite course? If yes, which? (Check all that apply.)
Yes
No
NAMI Family Education
TVC Parent-2-Parent
The cost of the course is $500 per person, to be paid by check (which must clear before the training start date), money order, cash, or credit card (online only). Please include payment with registration form.
I understand that completing this training does not guarantee my certification as a Family Support Specialist, and that I must apply for certification with the Tennessee Department of Mental Health/Office of Consumer Affairs on my own. ______________________________________ Signature
______________ Date
