Enrollment form to be completed by supervisors or administrative assistants. Fields marked with an * are required Which assignment applies to your enrollee?* CW Specialist Tribal Employee School Based Specialist Access VerificationPeople Soft ID and/or U#Either the specialist's People Soft ID or U# is required to complete the form (a follow-up email will be required once the missing item is acquired). I have a Specialist U# I have a Specialist People Soft ID I have both Specialist U#*Please enter the Specialist U# Specialist People Soft ID*Please enter the Specialist People Soft ID I have requested LMS Access for the Specialist* Yes No * LMS Access Request is required to complete this form LMS Request Instruction: Send email to email@example.com requesting LMS access for a new Child Welfare Specialist Provide the following information: PeopleSoft ID/Employee ID U# Full Name Email Phone # Job Title Service Area (ours is "Child Welfare") County Supervisor Name Computer Verification* Please verify your specialist has access to a laptop / desktop computer that can be used daily. This is required for enrollment into Core.Leave Verification*Have you approved any leave for your specialist? If yes, what are the dates? Yes No Leave dates*Location VerificationCORE is auto assigned based on the date the enrollment form is received. In the event your specialist cannot attend a certain location, please check your preferred location. (Please note: this location will not be guaranteed). Norman Tulsa ParticipantLegal Name* First Last Preferred Name Hire Date with Child Welfare* MM slash DD slash YYYY Previously a Child Welfare Specialist?*Please select...NoYesHiddenEmail* County Name*Please select...Adair 01Alfalfa 02Atoka 03Beaver 04Beckham 05Blaine 06Bryan 07Caddo 08Canadian ACanadian CCarter 10Cherokee 11Choctaw 12Cimarron 13Cleveland 14ACleveland 14BCoal 15Comanche 16Cotton 17Craig 18Creek 19Custer 20Delaware 21Dewey 22Ellis 23Garfield 24Garvin 25Grady 26Grant 27Greer 28Harmon 29Harper 30Haskell 31Hughes 32Jackson 33Jefferson 34Johnston 35Kay 36AKay 36CKingfisher 37Kiowa 38Latimer 39LeFlore 40Lincoln 41Logan 42Love 43Major 47Marshall 48Mayes 49McClain 44McCurtain 45McIntosh 46Murray 50Muskogee 51Noble 52Nowata 53Okfuskee 54Oklahoma 55AOklahoma 55BOklahoma 55COklahoma 55DOklahoma 55EOklahoma 55HOklahoma 55I – OKC (Hotline)Oklahoma 55I – Rogers (Hotline)Okmulgee 56Osage 57Ottawa 58Pawnee 59Payne 60Pittsburg 61Pontotoc 62Pottawatomie 63Pushmataha 64Roger Mills 65Rogers 66Seminole 67Sequoyah 68Stephens 69Texas 70Tillman 71Tulsa 7BTulsa 72CWagoner 73Washington 74Washita 75Woods 76Woodward 77Program Job Type*Please select...Adoptions (AS)Comp - CPS TrackComp - PP TrackCPS (Child Protective Services)FC (Foster Care)FSC (Family Centered Services)HotlinePP (Permanency Planning)School Based SpecialistParticipant Cell Number*(Specialist Information Only)Emergency Contact Number*(Specialist Information Only)Degree / Field of Study(For Data Collection Purposes) Home Address* Street Address Address Line 2 City State AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Administrative AssistantName* First Last Email* Phone*SupervisorName* First Last Email* Phone*District Director / Field ManagerName* First Last PhoneThis field is for validation purposes and should be left unchanged.