Training Completion Form

Instructions:
1. Please print, sign, and date this form and email to hr@axelliant.com.
2. Approval for access to software development environment and system will be granted upon
receipt of training completion form in Human Resources.

FIRST NAME LAST NAME

DEPARTMENT ROLE

EMAIL PHONE

TRAINING COMPLETION DATE

I hereby acknowledge that I have completed the requirements for Data Protection and Privacy
Awareness training. The training covered the following topics:

a) Data protection
b) Data Privacy
c) Administrative, physical, and technical safeguards in data management
d) Policies, procedures, and documentation
e) HIPAA compliance requirements

I understand the requirements for access to Axelliant’s software development environment and system
and my responsibilities as a system user. I agree to abide by the principles that were explained in this
training.

I understand that I am expected to conduct myself in an ethical and responsible manner in compliance
with the Principles of Responsibility at all times. I also acknowledge my failure to comply with these
principles can result in disciplinary action, up to and including termination.

I understand that if I have any questions about the training, materials presented or information not
addressed in the training, or if I encounter any problems, it is my responsibility to seek clarification
from Management or Compliance department.

NAME SIGNATURE DATE

Training Completion Form (Ver 1.1)