Virginia Certification Statement                          return to Virginia CE Classes on Line

Ed Smith School, LLC

Print  this form and Submit when you have completed your course

It is required for course completion.

Fax to Ed Smith school at 1 - 410 - 213 - 2638

or  return by mail  to

 Ed Smith School, PO Box 371, Ocean City, Maryland 21843

Certification Statement

"I certify that I personally completed each assigned lesson of instruction"

Date : _____________  

 ___________________________

 Please Print  Your Name on the above line

________________________

Student's signature

Social Security Number :________________

Virginia License Number: ________________

Print your email address: ______________________________________

This form must be notarized