Practitioner:Program

IndividualLearning Plan: This form is completed for each CSC funded position in the program (inclusive of frontline staff and supervisors) and kept on file at the program.

Practitioner:Program:

Has completed learning requirements/required trainings outlined in contract

Has not completed learning requirements/required trainings outlined in contract. If this box is checked, include attendance and implementation of these trainings on the learning plan.

Practitioner’s signatureDateSupervisor’s signatureDate

ProgramLearning Plan: This form is completed for each CSC funded program. Part A and Part B must be submitted to your CSC Program Officer per contractual requirements.

Agency:

Program:

Person completing form/Title:

email address for feedback:

Part A

Part B

Please identify the number of staff who have the trainings below on their learning plans:

Please note a training’s inclusion on this list does not guarantee that CSC will be offering it in the contract term. Offerings are contingent upon a minimal capacity being met.

Program Director’s signatureDateExecutive Director’s signatureDate

To be submitted by April 30, 2017 for implementation FY 2017-18 (10/01/17-09/30/18)