Non-LSU Program Background Check and Training Certification Form

Non-LSU Program Background Check and Training Certification Form

Name

Title

Program/Activity

Department's Name

Start Date of Program

End Date of Program

Verification Statement

By submitting this form, I certify that all adults including program staff, authorized adults, volunteers, etc., working or volunteering for this program/activity being hosted or sponsored by this department during these dates have successfully completed the Basic Training For Adults Working and Youth Programs and a background check in compliance with PM-16 and LSU Human Resource Policy.

Signature

Date

Send me a copy of my responses

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