Certification of Completion
ining in Wlentification and Reporting of Child Abuse and Maltreatment)
Part Ar Trance Information
This forms al hat you need as poof that you have completed your mandated traning. For al professions which
‘rvolve working ina Stoo. you" ceficate nil be sent etronicaly fo the Sale ae Shad appear on jour
‘TEACH account winin a wook For all Feensing not related toe the Education professions, sign and dato tho
‘om, ang then send ito the state along with your icense application. Tis fom = ust one requrement for
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GENUS GENUS OF NY NC 17200016
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Contficate #217116