Verified Course - POWER - Annual Report

As a provider of a Verified Course in the Power Domain, you are asked to report annual participation data for that Course. Additionally, we would like to get your feedback on the Verified Course Program and your use of the Mark.

Please complete this report within 90 days of the close of each Calendar Year in which the Course held the Verified Mark.

Thank you.

Question Title

* 1. PROVIDER INFORMATION (required)

Course Provider *

Verification Mark Number

Address *

City/Town *

State/Province *

ZIP/Postal Code *

Email Address *

Phone Number *

Question Title

* 2. RESPONDENT INFORMATION (required - contact for questions about survey responses)

Name

Title

Email Address

Phone Number

Question Title

* 3. REPORT PERIOD - CALENDAR YEAR

EXPLAIN if this is not a full year report

Question Title

* 4. Summary Course Participation Data: In Question 5, you will upload a PDF copy of the Microsoft® Excel worksheet you completed on Course Participation Data for this Verified Course in the Power domain. In this Question, please enter just the GRAND TOTALS for the following (numerical data only):

Courses Delivered

Students Enrolled

Children/Youth (≤ 17 yrs) Enrolled

Adults (18+ yrs) Enrolled

(Total) Certificates Awarded

Certificates Awarded to Students who Completed On-Water Instruction

Certified Instructors

Question Title

* 1. PROVIDER INFORMATION (required)

Question Title

* 2. RESPONDENT INFORMATION (required - contact for questions about survey responses)

Question Title

* 3. REPORT PERIOD - CALENDAR YEAR

Question Title

* 4. Summary Course Participation Data: In Question 5, you will upload a PDF copy of the Microsoft® Excel worksheet you completed on Course Participation Data for this Verified Course in the Power domain. In this Question, please enter just the GRAND TOTALS for the following (numerical data only):

Question Title

* 5. Detailed Course Participation Data (PDF copy)