Certificate Request Form

If you have completed official REVIVE! training, please fill out the form below to request a certificate. Please allow up to 14 business days to receive your certificate.

If you want to inquire about the status of your Certificate, please email revive@dbhds.virginia.gov.

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* 1. Which REVIVE! training did you complete?

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* 2. Date of Training:

Date

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* 3. Who was the instructor of your training?

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* 4. What is your profession?

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* 5. Please provide your email address for certificate delivery.

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* 6. City/County and Zip Code (please do not put street address)

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