Annual Training Certification Form for Elected Officials

2. Broward Code of Ethics for Elected Officials

4. Name of Elected Official

6. Title

8. Government Entity

10. Current Term Begins On
    Current Term Begins On

11. Current Term Expires On
    Current Term Expires On

12. Reporting Period

14. All new officials check and complete if applicable.

16. I certify that I participated in 4 hours or more of training in public service ethics, Sunshine law, and public records, within 120 days of taking office and during reporting period, as follows:

18. Date(s) of training:

23. Entity providing training:

25. Amount of training provided:

27. All officials check and complete one of the following 3 boxes:

29. I certify that I was in office during the entire calendar year being reported and participated in 8 hours or more of training in public service ethics during the reporting period, as follows:

31. Date(s) of training:

36. Entity providing training:

38. Amount of training provided:

40. I certify that I took office on or before September 30 of the calendar year being reported and participated in 40 minutes or more of training in public service ethics for each full calendar month I was in office during the reporting period, as follows:

42. Number of full calendar months in office in the calendar year being reported:

44. Date(s) of training:

49. Entity providing training:

51. Total amount of training provided (included any reported above):

53. I certify that I took office on or after October 1 of the calendar year being reported.

55. Check and complete if applicable:

    Check here if this form amends a previously filed form.

57. This form replaces all previously filed forms for calendar year:

59. Signature of Elected Official

60. Date of Signature
    Date of Signature

Leave This Blank:


61. 1. Receive an email copy of this form.
62. Email address

    This field is not part of the form submission.

63. Submit

* indicates a required field