SAFE-D Webcast Credit Application

I certify that I participated in the ABCs of ESDs webcast online and am entitled to receive two-and-a-half (2,5) hours of ESD Commissioner Training Credit. I understand that false statements on this application may lead to significant penalties.

In the blanks below, fill in the two keywords supplied during the webcast. Both keywords are required for the credit application to be processed.

First Keyword

Second Keyword

Name*

First NameLast Name

E-mail*

County*

ESD Name*

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Phone Number*

Area CodePhone Number

Please rate the value of this training

ExcellentGoodPoor

Comments about this training?

Use your mouse (on your PC) or your finger (on your mobile device) to sign the form.

Signature

NEW: BEFORE you click SUBMIT below, click the PRINT FORM button (below) to print the form for your records until you receive an emailed form from VG Young Institute.

This form will be available until May 31, 2022. After that date, credit application will not be available. Please note: Payment must be received for credit hours to be processed. Educational sponsor: V.G. Young Institute of County Government, Texas A&M AgriLife Extension Service.

SAFE-D Credit Application