(267) 247-55841456 Ferry Road, Suite 404 Doylestown, PA 18901

Facebook page opens in new window Instagram page opens in new window Linkedin page opens in new window X page opens in new window YouTube page opens in new window

Foundations Community Partnership

Home
About
Grants
Events
Summer Youth Corps
Scholarships
Resources
Support
Contact

Home
About
Grants
Events
Summer Youth Corps
Scholarships
Resources
Support
Contact

Category: FCP 2009 Fall Workshops

Welcome To the FCP 2009 Fall Workshops!

Dr. Dan's Blog, FCP 2009 Fall WorkshopsSeptember 29, 2009

Welcome To the FCP 2009 Fall Workshops! This Fall (2009), Foundations Community Partnership will present two informative and exciting workshops for mental health professionals, educators, consumers and all others interested…

Read post

Support FCP’s Work in Bucks County

FCP supports the behavioral health and human service needs of children, young adults, and families in Bucks County, Pa. We do this through innovative services and key partnerships with the public and private sector.

Support FCP

Foundations Community Partnership

1456 Ferry Road, Suite 404
Doylestown, PA 18901

(267) 247-5584
(267) 247-5598 fax

info@fcpartnership.org

Foundations Community Partnership

1456 Ferry Road, Suite 404
Doylestown, PA 18901

(267) 247-5584
(267) 247-5598 fax

info@fcpartnership.org

Join FCP's Mailing List

Facebook Instagram Linkedin Twitter Youtube

Go to Top

Meeting Space Reservation

Room Choice(Required)

Type of Meeting(Required)

Preferred Date(Required)

Month

Day

Year

Backup Date(Required)

Month

Day

Year

Reservation Start/End Time(Required)

Please include setup and take-down time in your reservation.

Number of Attendees(Required)

Purpose(Required)

Please describe the gathering.

Organization(Required)

Employer Identification Number (EIN)(Required)

Contact Person(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Mobile Phone(Required)

Email(Required)

Proof of 501(c)(3) status(Required)

Max. file size: 768 MB.

Please upload a scan of your organization's 501(c)(3) status document.

Additional comments about your reservation and/or equipment needs

Representative Signature(Required)

Date(Required)

SYC Emergency Contact Form

Name(Required)

Emergency Contact Person

Relationship

Best Phone Number for Emergency Contact

Secondary Phone Number

Back-up Contact Names

Please list names/phone number of any other individuals we could call in case of emergency in case your primary contact is not reachable.

Back-up Contact Names & Numbers

Health Conditions/Allergies

Do you have any allergies or health conditions that we should be aware of?

Motor Vehicle Report Permission

Full Name

Date of Birth

Driver's License #

Authorization for Obtaining MVR Information

Yes

As a prospective employee or employee of FCP, I understand that FCP as part of their driver control plan will order my MVR from time to time. I understand that this report will be kept in my personnel file as part of my record. I further understand that I am entitled to a copy of my MVR upon request. Under the provisions of the Fair Credit Reporting Act, 15 USC, Section 1681 et seq., the Americans with Disabilities Act and all applicable federal, state, and local laws, I hereby authorize and permit Foundations Community Partnership or FCP’s insurance broker or commercial auto insurance carrier to obtain my MVR. I agree that a copy of this authorization has the same effect as an original.

Full Name and Date

PA Criminal Background Check

First Name(Required)

Last Name(Required)

Middle Name

Date of Birth(Required)

Identity Theft #

Social Security Number (recommended)

Race

Sex

Female

Male

Nonbinary

Alias First Name

If you have more than one alias, please let Caroline know.

Alias Middle Name

Alias Last Name

Workshop Evaluation

Name(Required)

Full Street Address/City/State/Zip(Required)

Email Address(Required)

Phone Number(Required)

Certificate Sought(Required)

Psychologist

Social Work/LPC/MFT

NBCC

General Attendance Only

Choose General Attendance Only if you are not seeking CE Credit.

I would like my CE Certificate mailed to the above address.

Yes

Otherwise all CE certificates will be emailed as PDF documents.

Please Rate this Professional Education Workshop, Items 1 - 8

Using the following scale: 4 = Excellent, 3 = Good, 2 = Fair, 1 = Poor

1. At the end of this activity, the learner will be able to summarize current telehealth standards, as well as relevant ethical concerns.(Required)

2. At the end of this activity, the learner will be able to explain strategies for improving the delivery of telehealth-based counseling.(Required)

3. At the end of this activity, the learner will be able to discuss recent research related to the practice of telehealth-based counseling.(Required)

4. Please rate the expertise of the presenter, Charles Jacob, M.S.Ed., Ph.D.(Required)

5. Please rate the appropriateness of the teaching strategies used by the presenter.(Required)

6. Please rate the degree to which opportunities for questions/answers met your needs.(Required)

7. Rate the ease of registration and the helpfulness of staff overseeing the workshop.

8. Please rate how well this online platform worked for you.

9. How useful was the content of this CE program for your practice or other professional development?(Required)

5 = Extremely Useful

4 = Very Useful

3 = Somewhat Useful

2 = A Little Useful

1 = Not Useful

10. How much did you learn as a result of this CE program?(Required)

5 = Extremely Useful

4 = Very Useful

3 = Somewhat Useful

2 = A Little Useful

1 = Not Useful

What future topics would you like FCP to present for Professional Education Workshops?

We value your comments! Thank you!

Host Agency Application

Agency

Agency Website

Agency Address

Contact Name

Email Address

Phone #

Agency Description/Mission

Service-Learning Opportunities & Potential Intern Assignments

Please describe the activities/duties you would anticipate for an intern. Include one to three measurable outcome goals for the internship.

Days/Hours of Agency Operations

What days/hours would the intern work most weeks?

Additional Information and/or Special Conditions or Requirements of Intern, such as regular travel between agency locations.

COVID Vaccination

Yes

Do you require proof of a COVID vaccination for intern employment? If yes, please note any specifics, if applicable.

COVID Vaccine Requirements, if applicable

Intern Supervisor

Please provide name/information for one primary supervisor who will be responsible for managing the intern and communicating with FCP.

Intern Supervisor's Resume or Qualifications

Max. file size: 768 MB.

Please upload a copy of your organization's 501c3 status.

Max. file size: 768 MB.

Please upload your organization's liability insurance certificate, showing coverage for student/interns/volunteers.

Max. file size: 768 MB.

Does the organization, or any of its officers or directors have a personal, financial, or employment relationship with Foundations Community Partnership?

Yes

If yes, please describe the nature of this relationship:

Representative Signature

Date