<p> IMPACT Leader Certification</p><p>Registration: Must be e-mailed to [email protected] . Space is limited to 20 participants per class. There will be no provision for on-site registration or payment. DFCS supervisors should use the online registration system to register DFCS staff, foster parents, and contractors for this class. Private agencies (including individuals who plan to contract with DFCS in the future) should use the attached form to register for this class.</p><p>Fee: Private agency registration fee is $175 for the IMPACT Family Centered Practice Train the Trainer (New certification Only- 5 day course). All fees are due before the training. ***All checks and money orders should be made payable to HROD/DHR.*** Please ensure that the name of the registrant is written on the check or money order. Please forward your payment to:</p><p>DaJaneshia Cade Re: IMPACT Leader Certification DFCS Education and Training Services 2 Peachtree Street, NW Ste 26-267 Atlanta, GA 30303-3142</p><p>Registration Process: Your registration will not be completed until your check has been received and processed by the Registrar. Please note that you are asked to submit three choices for your class in order of preference. If your first choice is full when your check is received, you will be bumped to your second choice and so forth. You will be notified by the Registration System once your information has been confirmed and placed into the system. If the dates and location are not ideal, please follow the cancellation process outlined below.</p><p>Confirmation Letters: Confirmation letters will be generated by the computer once your Registration form and fee have been received.</p><p>Cancellation Policy: If you are unable to attend the training, please e-mail our registration office at [email protected] . Division of Family and Children Services IMPACT Leader Certification</p><p>REGISTRATION FORM State of Georgia DFCS Division (Please print clearly and completely) Name (F, MI, L):</p><p>Social Security No.</p><p>Title: Name of Supervisor Phone: Supervisor Organization:</p><p>Address:</p><p>City, State, Zip:</p><p>Phone: Fax:</p><p>E-mail: (PLEASE INCLUDE) Preference 1st Choice 2nd Choice 3rd Choice</p><p>Date of Training Location of Training Class Taking: OCP 204U IMPACT FCP -5 Day (Check one) Training (New certification) Cost: $175</p><p>Registration: Must be e-mailed to [email protected]. Space is limited to 20 participants per class. There will be no provision for on-site registration or payment.</p><p>Fee: Private agency registration fee is $100 for the 3 day class and $175 for the 5 day class. ***All checks and money orders should be made payable to HROD/DHR.*** Please ensure that the name of the registrant is written on the check or money order. Please forward your payment to:</p><p>DaJaneshia Cade Re: IMPACT Leader Certification DFCS Education and Training Services 2 Peachtree Street, NW Ste 26-267 Atlanta, GA 30303-3142 Confirmation Letters: Confirmation letters will be generated by the computer once your registration form and fee have been processed</p><p>Cancellation Policy: If you are unable to attend the training, please e-mail our registration office at [email protected].</p>