In order to receive your Certificate of Attendance or CEU, you must complete this form. This form is tracked separate to ensure your evaluation remains anonymous.

Each field within the Contact Information section is required to be completed before you can sumbit the form.

Attendance will be verified by the registration list and this electronic attendance verification.

After completing and submitting the form, your certificate will be emailed to you when available from the CEU provider.

* 1. Please provide the following information about yourself.

Reminder: Each field within the Contact Information section is required to be completed before you can sumbit the form.

* 2. Please verify your attendance at the WVSIIS WebEx

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