> Article: SFW Grandfathering In Application

SFW Grandfathering In Application


                                                                       


Last Name:  ______________________________

 First Name: ________________________    Middle Name/Initial:  ________________

Address:  __________________________________________________________________

Address2: _________________________________________________________________

City/State/ Zip Code:  ________________________________________________________

Phone #:  __________________________________

D.O.B.: ________________________  Gender (M/F):  ______________

Email Address:  _______________________________________________________

Current Employment:  __________________________________________________

# of Years in Position:  ___________________

Work Address:  ______________________________________________________________________

Work City/State/Zip:  __________________________________________________________________

Year Earned FDC:  ________________  State Earned FDC: ______________

Agency that provided training:  __________________________________________________

FDC Instructor Name: ___________________________________________________

Use FDC Concepts in Current Job?  (Y/N):________________________

Highest Education Level Completed:  _____________________________

Completed FDLC (Y/N): ________________  Year Completed FDLC: ________________

Completed Instructor’s Institute Y/N:_____________   Year Completed: __________________

Year last served as an instructor for FDC class:  _______________

Completed Portfolio Adviser (Y/N):_______________  Year Completed: __________________

Year last served as an Adviser for FDC class:  ______________

How should your name appear on the credential?  __________________________________________________

Please complete the application. 
In order to receive the SFW credential you must have earned the FDC credential previously.
Please print out the above application, complete it and submit it along with a $10 fee for processing to:

Temple University – Harrisburg Campus
234 Strawberry Square
Harrisburg, PA  17101
Attn.:  Andrea Warner


Please make the check or money order out to:  Temple University

{Please print your name and address legibly.  This is the information that will be used to send your credential.  }

If you have any questions you may contact Andrea Warner at (717) 232-6400 x228 or at andrea.warner@temple.edu  .