Online Form for EDITING/DEACTIVATING AN EXISTING PERSON in E-Track

Instructions for Completing this Online Form:

  1. Section One--all fields mandatory 
  2. Section Two--red fields mandatory, complete only those additional fields you want edited in the person's record
  3. NOTE: While all fields are not required, all fields are IMPORTANT.  Please UPDATE all fields that have changed for an individual.

SECTION ONE

Information on THE PERSON SUBMITTING THIS FORM (In case we have follow-up questions on the information you enter below):

YOUR Name: *  
YOUR RTC: *  
YOUR Phone #: *  
YOUR Email: *  

NOTE: This section must be completed, even if it is duplicative of information listed below.

SECTION TWO

Information on the Person Whose E-Track Record Needs to Be Edited--The assumption being that any non-required field completed below
needs to be changed in E-Track:

E-Track Login ID: *   (Put Xs in Field If You Do Not Yet Have Access to E-Track)
Legal First Name: *   (If new legal first name, enter old name then new name in box)
Middle Name:    
Legal Last Name: *   (If new legal last name, enter old name then new name in box)
Make Person Inactive:   (Check this box if person has retired, resigned, been terminated, etc.)
Preferred First Name:   (e.g., nickname)
Mailing Address Line 1:    
Mailing Address Line 2:    
Mailing Address Line 3:    
City:    
State/Province:    
Postal Code:    
Country:    
Preferred Phone #:    
Fax #:    
Preferred Email:    
UPP Status:
2-Digit Birth Month:    
2-Digit Birth Day:
Gender ID:    
Yrs. in Pub./Priv. Child Welfare:    
Current Job Effective Date:    
Supervisor:    
Secondary Supervisor:    
Staff Date Hired:   Use current licensure date for caregivers.
Years Fostering:    
Level of Foster Care Licensure:    
Caseworker IV-B ID:   NOTE: For non-caseworkers, enter N/A. For caseworkers select most-appropriate option.
Person Type:   NOTE: You may select multiple Person Types by holding down the "Ctrl" key and clicking.
Region:    
Agency:    
Alternate Phone:    
Alternate Email:    
Additional Notes:   Use this field to enter any additional comments or information that will help us to update this record.

PLEASE ALLOW UP TO ONE BUSINESS DAY FOR FORM TO BE PROCESSED.