Staff Education and Training Unit

Skip First Level Navigation | Skip All Navigation

Home > Registration Procedures > Registration Form

Application/Attendance Form

STAFF EDUCATION
&
TRAINING UNIT

Return to:Maine DHHS
Staff Education and Training Unit
#11 State House Station
Augusta, ME 04333-0011
Telephone: 287-9355
Fax: 287-9351
TTY: 1-800-606-0215
(Deaf/Hard of Hearing)

Name:	Last First MI
Agency:
Address:
City:	State: Zip Code:
Day time phone number: EXT:
TAMS Employee ID# OR Last 4 digits of SS#:

A. For all Non-DHHS Employees, please check the appropriate category below:

In order to take a training in this system you must work for a Non-profit agency providing services to clients of the Department of Health and Human Services:

22 Children (Child Welfare-Child and Family Services)
23 Children (Behavioral Health)
24 Adults (Mental Health)
25 Adults (Cognitive and Physical Disabilities)
26 Adoptive Parent (s)
27 Foster Parent (s)
28 All Other State Employees/Law Enforcement

B. Do you need special accommodations for a disability? No Yes (Please specify)

CANCELLATION POLICY:A Confirmation notice will be sent to you about one month prior to a program if you are accepted. You must cancel prior to the program by phone, fax, or e-mail. E-mail is the most accurate way to assure we recieve notification. After two "no-shows", participants will be ineligible for one year of SETU programs.
E-MAIL:dhs.setu@maine.gov WEB ADDRESS:www.maine.gov/dhs/setu/setu.htm (I have read and understood this policy? Yes)

C. Do you have Internet access?No Yes

If Yes what is your e-mail address:

D. FOR DHHS EMPLOYEES ONLY (PLEASE CHECK YOUR SERVICE AREA):

1 Administrative Services (Accounting, Audit, Personnel, etc.)
2 Adoption Services
3 Adults with Cognitive & Physical Disabilities
4 Adult Mental Health
5 Adult Protective Services
6 Aspire
7 Child Welfare (Child and Family Services)
8 Children's Services: Behavioral Health
9 Contracting Services
10 Disability Determination

11 Dorothea Dix Psychiatric Center
12 Eligibility Services (OIAS)
14 Licensing and Regulatory Services
15 Maine Care Services
16 Maine CDC & Prevention
17 Public Health Nurses
18 Office of Elder and Adult Services
19 Office of Substance Abuse
20 Riverview Psychiatric Center
21 Support Enforcement

E. Please check the box for the type of position which you now hold:(Check all that apply to you)
Administrator Supervisor Clerical Direct Services Other

F. Please indicate Class title, Class number, location, and date:

Class Title:		Class ID #:
Class Location:		Class Date(s):

Has this request for training been approved by your supervisor? NoYes--Date Approved:
Supervisor's Name: Supervisor's Phone Number:

If your application is accepted, you will be notified no later than two weeks prior to the beginning of the selected program. You will NOT be notified if your application is denied.

If you have any questions concerning this form, please contact us at 287-9355.

Maine.gov | Department Home | Agency Home | Site Policies