Annual Training Reporting Form Page 2

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Pre‐Approved Sponsor List Course:

Course Sponsor: _______________________________________________________________

Course Title: Dates Attended:________________

Sponsoring Agency: Hours Completed:__________

.........................................................................................................................................................

Pre‐Approved Sponsor List Course:

Course Sponsor: _______________________________________________________________

Course Title: Dates Attended:________________

Sponsoring Agency: Hours Completed:__________

.........................................................................................................................................................

Pre‐Approved Sponsor List Course:

Course Sponsor: _______________________________________________________________

Course Title: Dates Attended:________________

Sponsoring Agency: Hours Completed:__________

.........................................................................................................................................................

Pre‐Approved Sponsor List Course:

Course Sponsor: _______________________________________________________________

Course Title: Dates Attended:________________

Sponsoring Agency: Hours Completed:__________

.........................................................................................................................................................

*Instructions: Attendance at a course or conference delivered by a sponsor that is not listed above as a pre‐approved sponsor

does not automatically qualify as training credit hours. For approval, please send pertinent supporting documentation such as

the agenda, schedule information, and a course synopsis to the Board office.

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Total number of course training hours completed in calendar year:

Note: It is your responsibility to keep training attendance records, certificates of completion, or any

documentation from course attendance for audit purposes.

I certify that the information contained herein is true and complete to the best of my knowledge.

____________________________________________________

___________________________________

Signature of Applicant

Date