Fill and Sign the Year to Maintain Their Certification Form

20 19 JUVENILE OFFICERS CONTINUING EDUCATION CERTIFICATION COMPLIANCE FORM Juvenile officers are required to attend 12 hours of continuing education approved by the Juvenile Judge each year to maintain their certification. Please complete the following fo rm signed by the juvenile officer and the juvenile judge and return it to the AOC by February 2 8, 20 20 . Juvenile Officer ’s Name: ________________________________________________________ Mailing Address: ___________________________________________________ ___________ Judicial District: ______________ County(ies): ____________________________________ Phone: ( )____________ Fax: ( )____________ E -Mail address: _________________ Program Sponsor Date Hours Offered Hours Claimed TOTAL HOURS I, ____________________________________ (juvenile officer), certify that I am entitled to ____ hours of continuing education credit for 201 9. C laiming hours for session not actually attended is a violation of juvenile officer standards and could lead to loss of certification. Juvenile Officer ’s Signature: _______________________________ Date: ________________ Juvenile Division Judge’ s Signa ture: _________________________ Date: ________________ Return to Kenya Washington by fax at (501) 682 -2662 , by mail at 625 Marshall Street, Justice Building, Little Rock, AR 7220 1, or by email at kenya.w ashington@arcourts.gov no later than February 28, 20 20 .