CPR/FIRST AID COURSE REIMBURSEMENT SUBMISSION
Congratulations on completing your in-person AHA Infant, Child, and Adult CPR/FIRST AID Course certified course. Please complete the following information to initiate the reimbursement process. Make sure you retain your receipt and get your certification card. A CFSA staff person will reach out to you to verify. All information listed below is needed to support reimbursement that will be mailed to your home in the form of a check. When providing the cost of your class, add the amount before taxes. Additionally, each resource parent within the same household must complete a separate reimbursement form if both took the course. Reimbursement times vary but can be expected between 2 - 4 weeks after the request is submitted. This process is for CFSA Resource Parents ONLY and will only apply for courses taken through December 31, 2024. If there are any questions, please reach out to Trista Davis at trista.davis@dc.gov.
Name
*
First Name
Last Name
Email
*
example@example.com
Are you a CFSA Resource Parent
*
YES
NO
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Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone Number
*
Please enter a valid phone number.
Date of Class
*
-
Month
-
Day
Year
Date
Infant, Child, and Adult CPR/First Aid Course Vendor Name
*
Site Location
*
Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Until
until
Hour Minutes
AM
PM
AM/PM Option
Total 0.0
Total Cost (No Tax)
*
Foster Parent Support Worker
Did you receive a certificate?
*
YES
No
If you did not receive a certificate, when you are you projected to receive it?
My signature affirms that the information I have provided is accurate and truthful to the best of my knowledge and belief.
*
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At this time, CPR/1st Aid certification reimbursement is provided for CFSA Resource Parents. Please reach out to your Private Agency Resource Parent support team for further details.
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