GSOSW First Aid and CPR/AED Certification Submission

GSOSW First Aid and CPR/AED Certification Submission
Name on Certification*

First NameLast Name
Email*
Service Unit*
If submitting on behalf of another volunteer, please provide your first name, last name, and email address:
I am submitting:*

General First Aid, CPR and AED certificationMedical License

For those submitting general First Aid, CPR and AED certifications:

By signing below, I indicate that the certification I am submitting meets required GSUSA standards and Safety Activity Checkpoints. Specifically, it must:
- Be from an accredited provider, such as the American Red Cross, American Heart Association, or Medic First Aid.
- Include an in-person portion (the certification will say "Skills Portion completed" and/or include the instructor's name and facility).
- Certify in First Aid, CPR, and AED for both adults and children and must expressly state child or pediatric training was included on the certificate.
If my certification does not clearly state "Skills Portion completed" and/or the date I completed my skills training, the instructor's name, and the facility's name, I will submit this form with additional documentation to verify its completion.

If my certification does not clearly indicate adult AND child or pediatric training was completed, I will submit this form with additional documentation to verify that both children and adult First Aid, CPR, and AED topics were completed.
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For those submitting medical licenses:

By signing below, I indicate that my medical license is current and meets the required GSUSA First Aider standards and Safety Activity Checkpoints. Specifically, it must:
- Be verifiable in any applicable state databases.
- Have included an in-person portion for First Aid, CPR, and AED.
- Certify in First Aid, CPR, and AED for both adults and children.
Without additional documentation, GSOSW can generally accept certification from MDs, RNs, NPs, PAs, and CNAs. If I have a different medical license, I will submit additional documentation to verify that my coursework or continuing education included First Aid, CPR, and AED training for both children and adults.

I understand that the expiration date recorded by GSOSW will be the current expiration date recorded on my license. If I choose to renew my license and complete additional continuing education requirements outlined by my state or local government, I will resubmit my license at that time.
Signature*

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Please submit your certification and all additional documenation in the box below. You are able to upload multiple files in this spot.
File Upload*

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For all submissions:

If the submitted certification does not meet the standards below, GSOSW will not record the certification, and First Aider credit will not be awarded. If additional documentation is required to verify certification, you will need to resubmit this form.

Additional documentation requested may include a course syllabus or class description, an email from the instructor, or the backside of a certification wallet card.
Date of Completion*

MonthDayYear
Date
Date of Expiration*

MonthDayYear
Date
I affirm that the certification I am submitting meets all of the following GSUSA and Safety Activity Checkpoints requirements:*

The certification is from an accredited provider, such as the American Red Cross, American Heart Association, or Medic First Aid
The certification included an in-person portion
Certifies in First Aid, CPR, and AED for both adults AND children
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