Certificate Request

Use this form to let us know you’d like a certificate for a recent training.

In most circumstances, we will get you your certificate within one week from your request.

Please e-mail us at info@rootsup.info if you do not hear back within a week.

Name (as you want it to appear on your certificate)

First

Last

Phone (Just in case we have trouble reaching you by e-mail and have a question!)

Name of Training:

Date of Training (If multi-day, you can just put the date it start on!)

Sometimes people’s workplaces or certifying body requires a certificate in a deadname or other name someone doesn’t typically use in their day-to-day life. However, sometimes people also want a certificate they are able to show others or hang up, too.

For this reason, we are happy to provide you with a duplicate certificate so you can have one in the name required for work (or similar) and one in the name you actually use.

If you would like a duplicate certificate in a different name, please let us know here.

If you don’t need a duplicate certificate in a different name, you can leave this section blank.

does to you

Name (duplicate certificate, leave blank if you don't need a second certificate with a different name)

First

Last

Certifying Participation

Please sign below to certify that you have completed the required number of hours of this training to qualify to receive a certificate of completion.

Typically and unless other arrangements are made in a particular situation, this means you’ve missed no more than:

4 hours of a training that is 32 hours
2 hours of a training that is 14 to 31 hours
1 hour of a training that is 6 to 13 hours
30 minutes of a training that is 4 or 5 hours in length
0 minutes of a training that is 3 hours or shorter

Note: Where Continuing Ed credits are being issued from another certifying body, we will follow their requirements for missed time.

Please sign below to certify that you completed the required number of hours to qualify for a certificate of completion.

Clear Signature

Continuing Education Credits

Sometimes our trainings may be eligible for Continuing Education Credits for social workers, licensed mental health counselors, attorneys, etc. (If this is the case, you will know beforehand!)

If this training is eligible for Continuing Ed Credits and you will be claiming credits, please let us know here what kind of licensure you have or credits you will be claiming. (Certificates will be tailored to meet requirements for Continuing Ed Credits as applicable.)

Type of Continuing Ed Credits (Leave blank if this training does not offer credits or you do not have an applicable license or certification)

Anything else you want us to know about your request?