2026 MIPPA Training Unit Reporting Form
Please complete all of the following questions to report any Training Units completed to be reimbursed.  Each staff member that completes any unit will submit a reporting form separately for each training session.  You may have as many staff members complete as many units of training as you wish.  Reimbursement amount is $100/unit of training completed.  Questions? Comments? Wish to submit a training unit from a source not listed in the possible training list? Email Jessica.Ross@la.gov and I will approve additional alternative trainings completed. 
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Email *
Name of Agency (COA/AAA/ADRC) *
Training Completion Date *
MM
/
DD
/
YYYY
Title of Training * : *
Delivery Method (check all that apply) *
Required
Who completed this training? *
Name of staff member who completed training - enter one form for each staff member that completed each unit of training
Name of Training Provider or Source of Training (Multiple selections allowed) *
Training Topic:  (At least one Training Topic selection is required. Multiple selections allowed) *
Required
A copy of your responses will be emailed to the address you provided.
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