ECLN- New Home Visiting Managers Info Submission Form

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* 1. New Home Visiting Manager's name

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* 2. Work email address

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* 3. Work phone number

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* 4. Home Visiting Program name

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* 5. Program location (if applicable)

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* 6. Effective date

Date

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* 7. Is the new HV Manager taking the place of a manager who is no longer with NM CYFD Home Visiting?

Yes

Comments:

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* 8. If you answered "Yes" to Question 7, what is the previous manager’s name?

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* 9. If you answered "No" to Question 7, is this a newly added position or role within your program/organization?

Yes

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* 10. Managers who provide reflective supervision to home visiting staff are required to participate in monthly reflective calls facilitated by CDD Professional Development Team staff. Will this new HV Manager be providing reflective supervision to home visiting staff?

Yes

Comments:

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* 1. New Home Visiting Manager's name

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* 2. Work email address

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* 3. Work phone number

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* 4. Home Visiting Program name

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* 5. Program location (if applicable)

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* 6. Effective date

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* 7. Is the new HV Manager taking the place of a manager who is no longer with NM CYFD Home Visiting?

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* 8. If you answered "Yes" to Question 7, what is the previous manager’s name?

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* 9. If you answered "No" to Question 7, is this a newly added position or role within your program/organization?

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* 10. Managers who provide reflective supervision to home visiting staff are required to participate in monthly reflective calls facilitated by CDD Professional Development Team staff. Will this new HV Manager be providing reflective supervision to home visiting staff?

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* 11. Please tell us, briefly, the new HV Manager’s experience and background. This will help us to prepare new manager orientation materials.