1. POST COURSE REPORT Date of class Course conducted EX: HCP Address of class EX: 119 P. St., RM 1, LAFB, TX Your Training Site Name EX: 325 th AES Date course Start EX: 3/15/08 Date course completed EX: 3/15/08 Number Students Enrolled EX: 12 students Number of Students retrained EX: 8 students Number of cards Issued EX: 12 /0 cards Number of Instructor Renew EX: 0 student Lead instructor’s info EX: SGT Jose Smith, Phone 211-120-1555, email jsmith@jj.comjsmith@jj.com Signature + Title Program Director Signature Program Administrator Signature Program Administrator info Name of all instructors EX: SGT Jose Smith, USA Professional Licensure EX: EMT, RN AHA Instructor or TSF Cards exp. Date EX: 08/09 Enter with Card EX: Inst, TSF, or PD Renew at this time EX: Yes or No NOTE: AT THE END OF ALL LISTS ENTRY “LAST ENTRY”

2. Student name EX: John Doe A1C Professional Licensure EX: EMT, RN Entry student passed or failed the course Self explanatory Entry student passed or failed the course Self explanatory NOTE: AT THE END OF ALL LISTS ENTRY “LAST ENTRY” Self explanatory

3. Sample of Post Course Report HCP COURSE

4. Sample of Grade Report

5. MTN Course Evaluation NOTE: Your must summary this evaluation to one page and file with PCR