Member Training - Choices Attestation

Attention Employers of Record: If you represent more than one Member, please fill out an attestation for each of your Members. Fill out the form below and click submit. After you click submit, refresh the page and repeat for each Member.

Member Name

Member Name(Required)

Member CDTN Person ID

Member CDTN Person ID

Need help finding your CDTN Person ID?

Member Birthday

Member Birthday(Required)

Member Email

Member Email(Required)

Member Last Four Digits of Social Security Number

Member Last Four Digits of Social Security Number(Required)

Select one option:

Select one option:(Required)

The member completed this attestation.

The member's Employer of Record (EOR)/Representative completed this attestation.

Employer of Record (EOR)/Representative Name

Employer of Record (EOR)/Representative Name(Required)

EOR/Representative Email

EOR/Representative Email(Required)

Signature
By signing, I attest that this training was completed solely by me.

Signature(Required)

By submitting your information via this form, you agree to be contacted by CDCN via call, email, or text. To opt out, you can reply ‘stop’ at any time or click the unsubscribe link in the emails. For more information see our privacy policy. Message and data rates may apply.

Consumer Direct Care Network Privacy Policy

CAPTCHA