Completion Reporting Resubmission "*" indicates required fields Name* First Last Email* Enter Email Confirm Email Select the agency where we will report completion.* NYSED/TEACH PALS FL DBPR CA ABC Date of Birth (DOB)*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Course Completion Date*Month123456789101112Day12345678910111213141516171819202122232425262728293031Year202420232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920NYSED/TEACH Reporting: Course/Workshop Title*New York: DASA Dignity for All Students Act TrainingNew York: Child Abuse Identification and ReportingNew York: School Violence Prevention and InterventionNew York: Needs of Children with AutismNew York: Abuso Infantil Identificación e InformesNew York: Prevención e Intervención de la Violencia EscolarNYSED/TEACH Reporting: Social Security Number (SSN)*All 9 Digits PALS Reporting: Course Title*Pennsylvania: Mandated Reporter: PA Act 31 Renewal 2hr TrainingPennsylvania: Mandated Reporter: PA Act 31 Initial 3hr TrainingPALS Reporting: Social Security Number (SSN)*Last 4 Digits Only FL DBPR Reporting: Course Title*Florida: #1 Barber Training in HIV/AIDS Initial/Renewal 2hrFlorida: #1 Cosmetologist Training in HIV/AIDS Renewal 1hrFL DBPR Reporting: License Number* CA ABC Reporting: Course Title*California: #1 Responsible Beverage Service TrainingCurso de Servicio Responsable de Bebidas en CACA ABC Reporting: Server ID* Additional InformationShare any other details relevant to reporting completion.
