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CAOHC

Student Roster - CAOHC Course
(for Course Directors only)

A listing of students who have completed a CAOHC approved 20-hour certification course OR 8-hour recertification course. Course Directors: Please submit this form to CAOHC within 60 days of course completion. List only those who have successfully completed the course. You may fax this form to 414/276-2146 or mail to: CAOHC, 555 E. Wells Street, Suite 1100, Milwaukee, WI 53202-3823.

If you are submitting a student roster on your own form, or via electronic transmission, please include mailing address of student AND of their employer/supervisor.

CAOHC Course Director:*
CD# *
Dates of Course (mm/dd/yy):* to
 

20 hr course 8 hr course combined

(if combined is checked, please include in parentheses after each student's name whether the course is for certification or recertification)

Course Location: City:*
  State*
Course Director E-mail:* 
   
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* indicates required field