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Provider Agency Application

Please read the following prior to submitting the application below.


Statement of Need:  The provision of marriage education and counseling services strengthens and preserves Resource Families who are preparing to adopt or who have finalized an adoption of a child(ren) through Tennessee’s Department of Children’s Services. 

Overview of Provider Agency Criteria:  HMHF project utilizes the curriculum of the Prevention and Relationship Enhance Program (P.R.E.P.).  To strengthen a community’s capacity to better disseminate marriage education, HMHF identifies one (1) provider agency from each grand region to receive the PREP Instructor Training.  HMHF will provide the following expenses associated with two (2) provider agency staff, which are identified below, receiving the PREP Instructor Training: registration, curriculum, lodging, meals, and travel (federal per diem max for Nashville, TN).  Criteria for agency application are as follows:

  1. Provider agency criteria necessitates completion of application for review by grantee
  2. One (1) master’s level staff and one (1) bachelor level staff with relevant experience in adoption and/or resource family training
  3. The provision of twenty adoptive/resource families trained within the contract year: October 1, 2007 – September 31, 2008
  4. Participation in the evaluation process

For further questions, please contact Shea Watts, HMHF Lead Trainer, at 865.982.5225.

Provider Application

Applicant Name
Agency Name
Agency Type
Street Address
City
State Zip
County
Phone Number
Web Site
Applicant Email

Briefly describe agency’s experience with adoption:

Briefly describe agency’s experience with Resource Families:

Briefly describe agency’s experience with educational trainings:

Identified Trainer Information:

  
Name of Trainer:
Date of Hire: (mmddyyyy)
Years Experience working with Resource Families:
Years Direct Training Experience:

Degree:

   
Name of Trainer:
Date of Hire: (mmddyyyy)
Years Experience working with Resource Families:
Years Direct Training Experience:

Degree:

Additional Comments

HMHF has selected the three partner agencies for this coming year. However, we are still collecting applications from interested partner agencies to attend upcoming P.R.E.P. trainings in the near future. If interested, please submit the application and your agency will be contacted and considered for the next PREP training.

 

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