SUD Group Sign-In Sheet

Date:	Start Time:	End Time:
Topic of the Session:
Facilitator Printed Name, Credentials	Facilitator Signature, Title
Co-Facilitator Printed Name, Credentials	Co-Facilitator Signature, Title
DMC – number in group is a minimum of 2 and maximum of 12
Participants must print and sign their name. If they arrived late or left early, indicate exact time
Printed Name	Signature	Time (if different)
Start	End
1
2
3
4
5
6
7
8
9
10
11
12
Administrative Use Only: