Form Gen 1031 - Annual County Training Plan Page 2
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10STATE OF CALIFORNIA–HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
CURRENT
COUNTY
ANNUAL COUNTY TRAINING PLAN
FISCAL YEAR
PART I – DEMOGRAPHIC INFORMATION
A.
STAFF DEVELOPMENT OFFICER
1.
NAME
2.
TITLE
5.
FAX NUMBER
3.
MAILING ADDRESS
CITY
ZIP
4.
TELEPHONE
8.
PERCENT OF TIME SPENT
6.
INTERNET ELECTRONIC MAIL ADDRESS:
7.
PROGRAMS OR AREAS OF TRAINING RESPONSIBILITY (CHECK APPLICABLE BOX)
ON TRAINING
SERVICES
ELIGIBILITY
OTHER (SPECIFY) __________________
B.
OTHER STAFF DEVELOPMENT OFFICER – Use only for split training function
1.
NAME
2.
TITLE
5.
FAX NUMBER
3.
ADDRESS
CITY
ZIP
4.
TELEPHONE
6.
INTERNET ELECTRONIC MAIL ADDRESS:
7.
PROGRAMS OR AREAS OF TRAINING RESPONSIBILITY (CHECK APPLICABLE BOX)
8.
PERCENT OF TIME SPENT
ON TRAINING
SERVICES
ELIGIBILITY
OTHER (SPECIFY) __________________
If training function and/or responsibilities have been divided between more than two officers,
C.
STAFF DEVELOPMENT OFFICER:
check here
and attach additional sheets.
If an alternate format is more suitable, check here
and attach your budget. Please include
D.
STAFF DEVELOPMENT BUDGET:
definitions for those line items which are not commonly used.
SIGNIFICANT CHANGE FROM CURRENT F.Y.
NEXT F.Y.
ITEM
BUDGETED AMOUNTS 1/
% INCREASE
% DECREASE
1. Salaries and fringe benefits of staff assigned full time
2. Consultant fees
3. Outservice training
4. Tuition reimbursement
5. Other training contracts
6. Training equipment
7. Training facilities
8. Training supplies
9. Travel and per diem for staff development function
10. Other (specify)
11. TOTAL STAFF DEVELOPMENT BUDGET
COMMENTS ON SIGNIFICANT CHANGES (OPTIONAL)
1/ This budget is not intended to reflect the funding for staff development. You may include items in this column that are not eligible for reimbursement as staff
development expenses.
GEN 1031 (4/17) PART I
PAGE 2 OF 10
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