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G <br />ti <br />0 <br />KINDRED HEALTH CARE, INC. <br />an oar ^ o GA4 0 ,- _ ATTENDANCE ROSTER <br />Program Title: �VIACt SQA S-�QS Pe, rt Q Q,1't-- t'1'1 Ul+) Program Length: Date: q j A 1 a a 1 q <br />uV <br />Location of Progra`m:l ® Center E]District F-1Region ❑ Corporate CE Offering: ❑ No ❑ Yes- Number of Units: CE Activity Number: <br />Center Name: Eft Gakil p nS Center Number: 0 3o�-D Course Material Attached: ;K Yes <br />Trainer/Facilitator Name (Print): - ancL G Signature s <br />ignature of Trainer or Facilitator certifies that the foifowing persons attended the trainIter. <br />❑ No <br />ogee e P nnt) <br />Title <br />Signature <br />Last 4 SS# <br />Type of Training (Check one) <br />RB <br />CORE <br />Non -CCA <br />�'Et� Gt:• /-moi ` <br />Cs�� <br />� � <br />"A� <br />�L4-1 <br />r <br />LIU <br />tA/ <br />CA <br />y signature abewiffndidt9s end%tefremfn program identified on this form. <br />fib based <br />CORE Core <br />Non (rCA Nm -Corporate Camplianoe A meimnt QXAJ <br />FRM22001-02 (DI/11015) R <br />0 <br />C <br />