MA Responds Certificate of Completion Form

Individuals  who successfully complete all 9 modules of the MA Responds Volunteer Orientation Curriculum have the option to receive a certificate.  To apply for your certificate, please fill out the form below: 

 

First Name:*          

Last Name:*          

Address:*                

Email Address:*    

Phone:*                  

Volunteer Unit or Medical Reserve Corps Unit  (if applicable): 

 

*Fields marked with * are required

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