Mandated Reporter Training Certification Submission

Contact Information
Name*
First Last
Email*
Please use the email address associated with your myGS account.
Enter Email Confirm Email
Zip Code*
Which of these most closely describes your current position with GSGLA?*
Please Describe:
Service Unit*
Troop # (Five Digits)
Would you like your certificate to apply to any additional troops?*
- Yes
- No
Please list any additional troop numbers. If providing more than one troop, please start each number with "Troop #".*
Do you need to list an additional service unit (different than the service unit listed previously)?*
- Yes
- No
Service Unit*
If you would like to be listed under more than two service units, please email livescan@girlscoutsla.org.
Certificate Information
Which will you be providing?*
- AB 506 state mandated reporter training certificate
- Current mandated reporter professional license
- Other evidence of mandated reporter occupation
Date of Training Completion
MM slash DD slash YYYY
Please upload your certificate, license or other evidence here:*
Max. file size: 100 MB.
Today's Date*
MM slash DD slash YYYY
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