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Get CDA Renewal Candidate Training Verification Form

CDA Renewal Candidate Training Verification Form To Be Completed by the Center/Program Director or other Authorized Staff Use this form only If the CDA Renewal Candidate has certificates as proof of training or received training from multiple sources. Please print/type legibly and be sure to retain a photocopy for your records. Renewal Candidate s Name Candidate s Current Position I Authorized Staff verify that I have reviewed the above named Renewal Candidate s training record and have verified all of the following Training was in the form of 3 college credits 4. 5 CEUS or 45 clock hours Training documentation is either in the form of a college transcript official certificates or a letter on letterhead from the training agency. All training documentation contained the training agency name agency official seal/logo Candidate Name Training Topic credits/hours/CEUS awarded Date of Training and Official Signature. Training was taken after the issue date on the Candidate s most current credential not to exceed five years. range of the Candidate s original credential endorsement. I verify that I am the authorized person identified or named in this form and I attest to the accuracy of the above Statements. I understand that the Council will conduct random audits and may contact me regarding the contents of this form* Signature Date Title The Council reserves the right to request training documentation be submitted directly to the Council*. Please print/type legibly and be sure to retain a photocopy for your records. Renewal Candidate s Name Candidate s Current Position I Authorized Staff verify that I have reviewed the above named Renewal Candidate s training record and have verified all of the following Training was in the form of 3 college credits 4. 5 CEUS or 45 clock hours Training documentation is either in the form of a college transcript official certificates or a letter on letterhead from the training agency. 5 CEUS or 45 clock hours Training documentation is either in the form of a college transcript official certificates or a letter on letterhead from the training agency. All training documentation contained the training agency name agency official seal/logo Candidate Name Training Topic credits/hours/CEUS awarded Date of Training and Official Signature. All training documentation contained the training agency name agency official seal/logo Candidate Name Training Topic credits/hours/CEUS awarded Date of Training and Official Signature. Training was taken after the issue date on the Candidate s most current credential not to exceed five years. Training was taken after the issue date on the Candidate s most current credential not to exceed five years. range of the Candidate s original credential endorsement. I verify that I am the authorized person identified or named in this form and I attest to the accuracy of the above Statements. .

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