Compliance Training Attestation Form First Name* Last Name* Email* UConn Health Affiliation*Choose One:AMASBoard of DirectorsContractorDental Resident (Capital Area Health Consortium)Dental StudentDual Degree StudentEnable CompGraduate StudentGraduate Certificate StudentHealth Research Program Student ResearcherLaw School Student InternManchester Dental Assisting StudentsMedical Resident/Fellow (Capital Area Health Consortium)Medical StudentMorrison EmployeeMPH StudentMS StudentNon-Employed Medical StaffNursing StudentOMSF Externship ParticipantPA StudentPhD StudentRayas (Vendor)Research AffiliateShields Health SolutionsStudent InternTravel NurseTunxis Dental Assistant StudentTunxis Dental Hygiene StudentTunxis Dental Hygiene InstructorTunxis Front Desk StaffUConn Storrs EmployeeUniversity of Connecticut Health LeadersVendorVisiting Research StudentVolunteerVolunteer Dental FacultyYoung Innovative Investigator Program (YIIP) ScholarDepartment/Program Affiliation* By completing and submitting this form, I acknowledge that:I have received and carefully reviewed the self-learning compliance training packet, and any referenced resources or links, which included, but may be not limited to:* UConn Health’s Policies and Standards Reporting a Compliance Concern Fraud, Waste, and Abuse Laws and Prevention HIPAA Privacy Policies and Rules Information Security Policies and Rules By checking yes, I attest that the statements below are true:I understand:* I should report compliance concerns to any of the offices mentioned in the training,or by using the University’s 24/7 anonymous REPORTLINE. University policy prohibits retaliation against any individual reporting good-faith concerns or participating in an investigation. It is my responsibility to comply with all UConn Health policies and procedures and applicable laws and regulations. I agree to abide by all policies and procedures referenced in this training, including the University’s Code of Conduct, and I know where to find such policies for reference. CAPTCHANameThis field is for validation purposes and should be left unchanged.