FTC FTC Date: No: No: Date: No: No: _________________ _________________ VERIFICATION VERIFICATION DOSA DOSA learn? learn? or or GROUP GROUP SAC SAC interest interest of of Representative: Representative: Yes: Yes: Yes: Yes: of of hear hear Name: Name: DC DC Group: Group: you you Group? speak? speak? of of did did you you SUPPORT SUPPORT Signature What Signature What Name Did Name Did Participants Time: Anchor Topic: Participants Time: Anchor Topic: _________________________________________________ _________________________________________________ FTC FTC Date: No: No: Date: No: No: _________________ _________________ VERIFICATION VERIFICATION DOSA DOSA learn? learn? or or GROUP GROUP SAC SAC interest interest of of Representative: Representative: Yes: Yes: Yes: Yes: of of hear hear Name: Name: DC DC Group: Group: you you Group? Group? speak? speak? of of did did you you SUPPORT SUPPORT Signature What Signature What Name Did Name Did Participants Anchor Participants Anchor Time: Topic: _________________________________________________ Time: Topic: _________________________________________________ DRUG/ALCOHOL TESTING
SUPPORT GROUP VERIFICATION DC SAC DOSA FTC Participants Name: Name of Group: Time: Date: Signature of Representative: Anchor Group? Yes: No: Topic: Did you speak? Yes: No: What did you hear of interest or learn? _________________ _________________________________________________ SUPPORT GROUP VERIFICATION DC SAC DOSA FTC Participants Name: Name of Group: Time: Date: Signature of Representative: Anchor Yes: No: Topic: Did you speak? Yes: No: What did you hear of interest or learn? _________________ _________________________________________________ SUPPORT GROUP VERIFICATION DC SAC DOSA FTC Participants Name: Name of Group: Time: Date: Signature of Representative: Anchor Group? Yes: No: Topic: Did you speak? Yes: No: What did you hear of interest or learn? _________________ _________________________________________________ SUPPORT GROUP VERIFICATION DC SAC DOSA FTC Participants Name: Name of Group: Time: Date: Signature of Representative: Anchor Group? Yes: No: Topic: Did you speak? Yes: No: What did you hear of interest or learn? _________________ _________________________________________________ DRUG/ALCOHOL TESTING