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Title IX: TSGBV Record of Attendance

Live remote training facilitated by TSGBV Staff and Contracted Speakers
To obtain TCOLE credit, your attendance MUST be documented on this form
You must complete and submit form by EOB on October 16, 2020, to receive credits.
You will receive a Certification of Completion if form is submitted at a later date. 
1.I certify that I attended online Training at the Texas Summit on Gender-Based Violence on the following days (select all that apply:)(Required.)
2.Total Number of Instruction Hours:(Required.)
Please use the same email address used to register for the webinar when completing this form. 
*Credit will not be given to any student who did not attend the full training. Exceptions will be made for students having internet connection issues. Please make a note in the NOTES field if internet issues caused you to miss any amount of time.
3.NOTES:
4.Email Address Used to Register for Webinar:(Required.)
5.Last Name, First Name:(Required.)
6.PID:(Required.)
7.DOB (xx/xx/xxxx):(Required.)
8.Agency:(Required.)
I certify that this is an accurate record of my attendance:
9.Signature:(Required.)
THIS IS AN OFFICIAL GOVERNMENT DOCUMENT. FALSIFICATION OF INFORMATION CAN RESULT IN ADMINISTRATIVE AND CRIMINAL ACTION.