Cultural Competency Training Attestation

Cultural Competency Trainings needs to be completely every year. Providers who have completed the Cultural Competency Trainings can complete the form below.

Practice Name *

TIN *

Practitioner Name *

Practice Phone Number *

What type of training did you attend? *

Attended an AHW presented webinar Attended another Cultural Competency training

The year attestation completed *

Check Box for attestation *

Attestat

Electronic Signature *