* 1. Please choose the school or department in which you qualify.

* 2. Last Name

* 3. First Name

* 4. Date 

Date / Time
/
/

* 5. I certify that I have received the training and information presented on internal controls standards and procedures as required by Indiana Code 5-11-1-27(g)(2).  Please enter the last four (4) digits of your Social Security Number as your electronic signature.

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