An NMSU Cooperative Extension Program
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Request Supervisor Verification for Completed YPSS Worksite Exposure Hours

Youth Peer Support

Once you have completed 40 hours of worksite exposure, complete this form to send a request to the agency supervisor to confirm your hours.

Your Name(Required)
Your Email(Required)
Provide the name of the agency where 40 worksite exposure hours were completed.
Supervisor Name(Required)
Supervisor's Email(Required)
Attestment Statement(Required)