Follow the steps to complete the form successfully.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. In Part I, provide your personal information including your name, ASCP Customer ID number, address, email address, city, state, zip code, and the last four digits of your Social Security number.
3. In Part II, ensure that this section is completed and signed by the program official to validate your application. The program official must confirm your eligibility for certification.
4. Under Classroom Instruction, fill in the training site details along with the start and end dates for your classroom training. Ensure you check the appropriate boxes confirming that you have completed the required 40 clock hours of classroom training.
5. For Clinical Instruction, provide information about the clinical training site, including start and end dates. Confirm the completion of the 100 clinical hours and the performance of 100 successful venipunctures by checking the designated areas.
6. The program official must sign the form, providing their name, title, date, telephone number, email address, institution, and, if applicable, the 6-digit school code.
7. Finally, ensure you attach a letter of authenticity from your program official, printed on original letterhead, to your Training Documentation Form before submission.
8. After completing all sections, save your changes, and consider downloading, printing, or sharing the form for your records.

Complete and submit your ASCP Structured Training Documentation Form online today to advance your certification process.