Sds361 form 2026

The document outlines the application process for the Oregon Home Care Commission's CPR/First Aid Certification Program. It details eligibility requirements, including having an active provider number and completing specific OHCC training classes. Prior approval is necessary before registering for certification courses, and reimbursement will not be provided for out-of-pocket expenses. The application form collects personal information and training history from applicants.

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Click ‘Get Form’ to open the sds361 form in the editor.
Begin by entering your First Name and Last Name in the designated fields. Ensure that these match your official identification.
Input your HCW Provider Number and PSW Provider Number. This information is crucial for verifying your eligibility.
Fill in your Phone Number, County in Oregon, and Mailing Address, including City, State, and ZIP Code.
Provide your Email Address for communication regarding your application status.
Select any Certifications Received from the list provided. This helps assess your qualifications.
Choose your Preferred Language from the options available to ensure clear communication.
List the last two training classes completed along with their dates. If you are recertifying, include four classes instead.
Once completed, submit the form via email, mail, or fax as indicated at the bottom of the document.

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Versions	Form popularity	Fillable & printable
2020	4.8 Satisfied (230 Votes)
2020	4.3 Satisfied (134 Votes)
2018	4.2 Satisfied (79 Votes)

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