Training Record Form - Uft
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1OCFS-LDSS-4699.3 (7/2006)
NEW YORK STATE
OFFICE OF CHILDREN AND FAMILY SERVICES
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Complete and return this form to the Enrollment Agency.
Child Care providers who have completed 10 or more hours of training in the areas listed below may be
eligible to receive an enhanced reimbursement rate once verified by the Enrollment Agency.
Principles of childhood development: focusing on the developmental stages of the age groups for
which your program provides care;
Child care program development;
Nutrition and health needs of infants and children, which may include the administration of medication;
Shaken baby syndrome: Education and information on the identification, diagnosis and prevention.
Child abuse and maltreatment: Identification and prevention;
Child abuse and maltreatment: Statutes and regulations;
Safety and security procedures;
Business record maintenance and management; or
Statutes and regulations pertaining to child day care.
PROVIDER NAME:
ENROLLMENT ID NUMBER:
SOCIAL SECURITY NUMBER:
Please list any child care training you have taken within the past 12 months, and attach documentation,
such as a training certificate.
TRAINING TOPIC:
DATE COMPLETED:
PRESENTING AGENCY:
NUMBER OF TRAINING HOURS:
1
VERIFIED (FOR ENROLLMENT AGENCY USE ONLY):
TRAINING TOPIC:
DATE COMPLETED:
PRESENTING AGENCY:
NUMBER OF TRAINING HOURS:
2
VERIFIED (FOR ENROLLMENT AGENCY USE ONLY):
TRAINING TOPIC:
DATE COMPLETED:
PRESENTING AGENCY:
NUMBER OF TRAINING HOURS:
3
VERIFIED (FOR ENROLLMENT AGENCY USE ONLY):
TRAINING TOPIC:
DATE COMPLETED:
PRESENTING AGENCY:
NUMBER OF TRAINING HOURS:
4
VERIFIED (FOR ENROLLMENT AGENCY USE ONLY):
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