Virtual Services Attendance Verification Form

Virtual Services Attendance Verification Form
Upon instruction of the group counselor, the participant is to complete the Virtual Service Attendance Verification Form.
Name:
First*
Last*
Email Address*
example@example.com
Location of Program (choose from dropdown)*
Date of session*

MonthDayYear
Date
Start Time of Session*

Hour Minutes

AM/PM Option
End Time of Time*

Hour Minutes

AM/PM Option
Name of counselor*
Session Topic/Name (provided by counselor)*
If you have any questions, please email:
By signing below, I verify that I logged into my scheduled virtual services session at or before the scheduled start time. I am in a secure setting with no other individuals present. My video display, sound, and microphone are all working so I can participate in my session. I understand that I am not allowed to take screenshots or videos of the virtual session in progress as that violates other participants privacy and doing so will lead to termination from the program.

I understand that I will be given attendance only if this form is completed and signed at the time of the session AND that the counselor verifies separately that I have attended the session from the beginning to the end of the scheduled session time.
Signature of Participant*

Clear
Start time of session
Name of counselor
Should be Empty: