Verification Statement

After fulfilling the Ethics Module requirement, complete and sign the Verification Statement below. Retain a copy of this signed statement to submit along with your CEPs at the end of your reporting period.

Name*
First Last
Email*
*
- I have completed the online ethics course for the ATA Certification Program’s Continuing Education requirement.
Date*
MM slash DD slash YYYY
Signature
Consent*
I am voluntarily providing my personal information to ATA and I consent to having such information transferred to, processed, and stored in the United States. I agree to the privacy policy.

This signed form should be printed and retained with the documentation of your earned CEPs. It only needs to be submitted once when requested at the end of the first three-year reporting period.