Certificate – Annual In-Service Training
I have "successfully completed" the training indicated in its entirety. "Successfully completed" means completion of all requirements (attendance, participation, tests, homework, readings, etc) as required.
For Annual In-Service Training, staff will find topics that relate to the individuals with whom they work. Include ALL required information. PRINT legibly unless a signature is required. Submit this Certificate to the office to show proof of training and keep a copy for your records.

LSD1 & PS: 4 hours related to the specific needs of at least one recipient being currently served (topics include health needs, community resources, person-centered planning, etc).

SLC: 8 hours training (topics include: affordable housing options, asset development, money management, specific health needs of recipients they are currently serving, accessing governmental benefits (food stamps, legal services), employment-related topics, etc).

Other Topics: household maintenance, household management, safety, emergency procedures, meal planning, meal preparation, nutrition, shopping, consumer skills, clothing care, self-care, manners, sexuality, money management, banking, time management, recreation, leisure, mobility, travel skills, civic responsibilities, interpersonal communication, advocacy, facilitation of relationships, support counseling, utilizing third party benefits, etc.
Course Title

Type of Training

(Classroom, Conference, Presentation, CD, Video, Webinar, Provider Meeting)
Entity Sponsoring Training

(Source of Training - APD, TCC, Delmarva, ARC, ASHI, NIH, AHCA, college name, etc)
Service Addressed

(SLC, LSD1, PS-Day, PS-Qtr)
Trainer Name

(Classroom) (If Provider Meeting, include APD trainer & trainer for company)
Trainer Signature

(Classroom) (If Provider Meeting, include APD trainer & trainer for company)
Date of Training
Day of Training
Training Times	Begin Time	End Time
Length of Training
Staff Name

Staff Signature

Label or Training Outline

(CD/Video)	Attach a copy of the CD/Video Label or a Training Outline
Course Syllabus/Agenda	Attach a copy of the Course Syllabus/Agenda
Common Abbreviations

APD-Agency for Persons with Disabilities	ASHI-American Safety and Health Institute	ARC-American Red Cross

NDSS-National Down Syndrome Society	TCC-Tallahassee Community College	NIH-National Institutes of Health

AHA-American Heart Association	NINDS-National Institute of Neurological Disorders and Stroke

CDC-Center for Disease Control and Prevention	NLM-National Library of Medicine	DD-Developmental Disability

AHCA-Agency for Health Care Administration	DCF-Department of Children & Families