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Concussion Proof of Certification

Coaches Concussion Certification
  1. If you received a concussion certificate from any qualified organization within the last year, please complete step three (3).
  2. After you take the test, you must return to this site to complete step three (3). Take the Certification Test: http://www.cdc.gov/concussion/HeadsUp/online_training.html
  3. Once you have taken the test, please complete the form below and KEEP A COPY OF YOUR CERTIFICATE FOR AUDIT PURPOSES.
First Name (*)
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Last Name (*)
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Address (*)
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City (*)
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State (*)
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ZIP Code (*)
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Email Address (*)
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Did you pass the concussion test? (*)
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Certificate Date (*)
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You are required to keep a copy of your certificate to support future auditing.
By completing this form you are certifying that all the above information is correct to the best of your knowledge.

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