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J% <br />KINDRED HEALTH CARE, INC. <br />ATTENDANCE ROSTER Pt <br />Program Title: _ D �^ Program Length: �'Jyt'1 t °'� Date: � <br />Location of Program: ❑ Center ❑ District 0 <br />Region ❑ Corporate CE Offering: ❑ No ❑ Yes - Number of Units: CE kfiviiy Number: <br />Center Name: Center Number: Course Material Attached: ❑ Yes ❑ No <br />TrainerfFacilitator Name (Print): Signature: <br />Signature of Trainer or Facilitator certifies that the following persons attended the tralaing. <br />Employee Name (Please Print) <br />Title <br />Signature <br />Last 4 SS# <br />Type of Trainin Check one <br />RB <br />CORE <br />Nan -CCA <br />VQ <br />A! 13 --T D7 -Ty <br />-IZNJ- <br />wig <br />�6 01 <br />tun <br />L X— <br />r hQ <br />.4& <br />VV <br />My signature above Indicates I attended the training program identified on this form, <br />RB Role Based <br />CORS_ Con: <br />Non -CCA Non -Corporate Cam noa Agreement CCA <br />FRM 22001-02 (0111 &108) R <br />Page C-- Of <br />0 <br />O <br />M <br />