I certify that this company will only use qualified instructors that have been approved by the Colorado Department of Public Health and Environment for each course they teach. I certify that all statements made in this applicaiton are, to the best of my knowledge, correct and complete. (Note: Providing false statements in this application or providing fraudulent identificaiton constitutes second degree perjury as defined by 18-8-503, C.R.S.)
For the purposes of this form, the Colorado Department of Public Health and Environment accepts your typed name, title and date as an electronic signature equivalent to your valid signature on a paper copy of the form. As such, this electronically completed form subjects the signatory to the same responsibilities as a hand-signed form. Per Section 18-8-306, C.R.S., it is a felony to submit false information to a state official.