1. a) Student identification, including name, complete home address and Social Security number;
2. b) Training program identification number;
3. c) Program start and end dates;
4. d) Signature, or other verification as prescribed by the Department, of the Program Instructor and Approved Evaluator, when appropriate. (Any additional signatures are optional.)

The program sponsor shall submit, within 30 days after program completion, an official roster of all students who have successfully completed the training program. The official roster shall include, but not be limited to, the following required information:

(Source: Amended at 48 Ill. Reg. 17753, effective December 2, 2024)