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Cornell Work Incentives Practitioner Training Application
Application to Participate in February 2021 Cornell WIP Training
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* Indicates required question
First Name
*
Your answer
Last Name
*
Your answer
Work Email Address
*
Your answer
Work Phone
*
Your answer
Agency Name
*
Your answer
Agency Street Address
*
Your answer
City/town
*
Your answer
Job Title
*
Your answer
I/My agency provides employment services to the those in the following populations:
*
I/DD
SPMI
SU
Other:
Required
Services Provided
*
Your answer
I/my agency contracts with the follow MCO(s)
*
Alliance
Cardinal
Eastpointe
Partners
Sandhills
Trillium
Vaya
Required
Counties Serived
*
Your answer
I am interested in completing the Work Incentives Practitioner training because:
*
Your answer
I wil be using this certification to directly provide benefits counseling to people who are considering work or working.
*
Yes
No
Possibly
If "possibly", please explain
Your answer
How many Credentialed Work Incentives Practitioners are currently employed with your agency?
*
Choose
0
1
2
3
4
5
Do you already have some knowledge of Work Incentives, Social Security, Medicaid, and other public benefits?
*
Yes
No
Please elaborate on your current knowledge
*
Your answer
Do you have the support of your supervisor to dedicate work time to utilizing your credential to provide benefits counseling?
*
Yes
No
After reading the description for the WIP training, can you commit the time to complete this training, exam, and case study, in order to receive the WIP Credential?
*
Yes
No
Do you feel like you are a good fit for researching and comprehending complex regulations and conveying the information in understandable terms?
*
Yes
No
Maybe
If you answered "maybe" to the above question, please elaborate:
*
Your answer
Please describe how you will use the Work Incentive Practitioner Credential (WIP-C) once obtained. Please include number of counties and consumers to be potentially be served.
*
Your answer
I commit to attending all 5 days of this class
*
Yes
No
I commit to attending completion of the exam.
*
Yes
No
I commit to attending completion of the required practicuum exercise after the exam, so to obtain the Work Incentive Practioner Credential.
*
Yes
No
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