Certificate of Completion
This certifies that the individual named has successfully completed the course requiremnt for:
Student Name: [fname] [lname]
S.S. Number or License Number: [answer_S.S. Number or License Number]
Course Name: [event_name]
Date of Course: [start_date]
Provider Name: [provider_name]
Provider Number: [provider_number] Number of Credits: [number_credits]
Address: [venue_address] [venue_city], [venue_state] [venue_zip]
Phone Number: [provider_phone]
Signature of Authorized Provider Official:
Title: President Date: [registration_date]
Certificate Instructions:
[certificate_content]