Badge Verification Form
Submit this form once you have completed all action items related to earning a badge. Your submission will be verified by headquarters and badges will presented on a quarterly basis (May, August, November, February) Thank you for keeping your promise.
First Name *
Your answer
Last Name *
Your answer
Email Address *
Your answer
Mailing Address (include street, city, state, and zip code) *
Your answer
How would you like to receive your badge: *
Badge Completed *
If required, write your short reflection in the space below: (no more than 300 words)
Your answer
Have proof?
Please email any required documentation, images, video or other proof to
Never submit passwords through Google Forms.
This form was created inside of because I said I would..