DA Form 5763-r "Child Development Services (Cds) Individual Education Plan (Iep) Family Child Care (FCC) Provisional Certification Training Record"

What Is DA Form 5763-r?

This is a military form that was released by the U.S. Department of the Army (DA) on July 1, 1989. The form, often mistakenly referred to as the DD Form 5763-r, is a military form used by and within the U.S. Army. As of today, no separate instructions for the form are provided by the DA.

Form Details:

  • A 2-page document available for download in PDF;
  • The latest version available from the Army Publishing Directorate;
  • Editable, free, and easy to use;

Download an up-to-date fillable DA Form 5763-r down below in PDF format or browse hundreds of other DA Forms stored in our online database.

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Download DA Form 5763-r "Child Development Services (Cds) Individual Education Plan (Iep) Family Child Care (FCC) Provisional Certification Training Record"

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CHILD DEVELOPMENT SERVICES (CDS) INDIVIDUAL EDUCATION PLAN (IEP)
FAMILY CHILD CARE (FCC) PROVISIONAL CERTIFICATION TRAINING RECORD
For use of this form, see AR 608-10, the proponent agency is DCSPER.
FCC PROVIDER
INSTALLATION
QTRS ADDRESS
DATE INITIAL FCC TRAINING BEGAN
DATE PROVISIONAL CERTIFICATION
DATE CERTIFICATION ISSUED
ISSUED
CREDIT HOURS
TRAINING REQUIREMENTS
DATE
MINIMUM
EARNED
FCC ORIENTATION
8
REGULATION AND SOPS
CHILD GROWTH AND DEVELOPMENT
CHILD PROGRAM ACTIVITIES
CHILD ACTIVITY SPACES
CHILD GUIDANCE TECHNIQUES
CHILD HEALTH AND NUTRITION
SAFETY AND EMERGENCY PROCEDURES
PARENT AND PUBLIC RELATIONS POLICIES
FCC BUSINESS PRACTICES
2
CHILD ABUSE AND NEGLECT IDENTIFICATION AND REPORTING
2
FIRST AID
3
CARDIO-PULMONARY RESUSCITATION (CPR)
3
COMMUNICABLE DISEASES AND ADMINISTERING MEDICATION
2
OTHER
TOTAL CREDIT HOURS REQUIRED
(Actual number of hours required to complete may exceed number of credit
20
hours given)
COMPONENT A: READINGS/VIDEOS
3
MINIMUM CREDIT HOURS REQUIRED
COMPONENT B: WORKSHOPS/CLASSES
CHILD ABUSE PREVENTION
2
MINIMUM CREDIT HOURS REQUIRED
4
APD LC v2.01ES
DA FORM 5763-R, JUL 1989
CHILD DEVELOPMENT SERVICES (CDS) INDIVIDUAL EDUCATION PLAN (IEP)
FAMILY CHILD CARE (FCC) PROVISIONAL CERTIFICATION TRAINING RECORD
For use of this form, see AR 608-10, the proponent agency is DCSPER.
FCC PROVIDER
INSTALLATION
QTRS ADDRESS
DATE INITIAL FCC TRAINING BEGAN
DATE PROVISIONAL CERTIFICATION
DATE CERTIFICATION ISSUED
ISSUED
CREDIT HOURS
TRAINING REQUIREMENTS
DATE
MINIMUM
EARNED
FCC ORIENTATION
8
REGULATION AND SOPS
CHILD GROWTH AND DEVELOPMENT
CHILD PROGRAM ACTIVITIES
CHILD ACTIVITY SPACES
CHILD GUIDANCE TECHNIQUES
CHILD HEALTH AND NUTRITION
SAFETY AND EMERGENCY PROCEDURES
PARENT AND PUBLIC RELATIONS POLICIES
FCC BUSINESS PRACTICES
2
CHILD ABUSE AND NEGLECT IDENTIFICATION AND REPORTING
2
FIRST AID
3
CARDIO-PULMONARY RESUSCITATION (CPR)
3
COMMUNICABLE DISEASES AND ADMINISTERING MEDICATION
2
OTHER
TOTAL CREDIT HOURS REQUIRED
(Actual number of hours required to complete may exceed number of credit
20
hours given)
COMPONENT A: READINGS/VIDEOS
3
MINIMUM CREDIT HOURS REQUIRED
COMPONENT B: WORKSHOPS/CLASSES
CHILD ABUSE PREVENTION
2
MINIMUM CREDIT HOURS REQUIRED
4
APD LC v2.01ES
DA FORM 5763-R, JUL 1989
CHILD DEVELOPMENT SERVICES (CDS) INDIVIDUAL EDUCATION PLAN (IEP)
FAMILY CHILD CARE (FCC) PROVISIONAL CERTIFICATION TRAINING RECORD
CREDIT HOURS
TRAINING REQUIREMENTS
DATE
MINIMUM
EARNED
COMPONENT C: OBSERVATIONS
CENTER
1
FCC HOME
1
MINIMUM CREDIT HOURS REQUIRED
2
COMPONENT D: HOME ENVIRONMENT RATING
WORKSHOP/INITIAL ASSESSMENT
1
EVALUATION & DEVELOPMENT OF IMPORTANT PLAN
1
FOLLOW-UP ASSESSMENT
1
FOLLOW-UP EVALUATION AND DEVELOPMENT OF IMPORTANT PLAN
1
MINIMUM CREDIT HOURS REQUIRED
4
COMPONENT E: SPECIAL PROJECT
MINIMUM CREDIT HOURS REQUIRED
2
COMPONENT F: INSTALLATION REQUIREMENTS
MINIMUM CREDIT HOURS REQUIRED
3
TOTAL CREDIT HOURS REQUIRED
(Actual number of hours
MIN 18
required to complete the unit may exceed number of credit hours given)
COMMENTS
FCC PROVIDER'S SIGNATURE
ADDRESS
DATE
TRAINER'S SIGNATURE/TITLE
ADDRESS
AUTOVON
DATE
DA FORM 5763-R, JUL 1989
2
APD LC v2.01ES
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