Self-Reliance Group Registration and Attendance Form

1 Self-Reliance Group Registration and Attendance FormGenderM/FMemberNew ConvertRecent MissionaryFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskFaithUse TimeOdedienceManage MoneyWork/ResponsibilitySolve ProblemsWork TogetherCommunicatePersevereIntegrityLea rning/EducationStay on TaskName of GroupFacilitatorDate and time of first meetingType of GroupStake / DistrictPlease fill out the personal information on this form.

2 The Church of Jesus Christ of Latter-day Saints (the Church ) collects this information in order to (1) provide you support as you participate in a Self-Reliance Group and share your progress with your ecclesiastical leaders, (2) track your progress so you can receive your completion certificate, (3) allow other Group members to contact you as needed, and (4) inform you about upcoming events. By providing your personal information, you authorize the Church and its affiliated entities to collect this information, process it, and transfer it to other countries. If you ever find that your information is not correct, you can ask to update it. Your information will be used in accordance with the Church s records management and confidentiality policies that can be viewed at My Path bookletCheck if you have an LDS AccountNameGroup Registration and Attendance form. The Group facilitator registers members of the Group at immediately after the first Group meeting.

3 To comply with data privacy laws, all Group members must verify that they have an LDS Account. Facilitators should encourage participants to obtain an LDS Account at They should help participants complete this process. If a Group member chooses not to obtain an LDS Account, their personal data should not be included on this form (name, phone # and Email address) In these cases a generic name should be recorded in the on-line Registration process to respect the privacy of the completion of the Self-Reliance Course In the 12th Group meeting,, each Group member will be asked to update their Self-Reliance assessment in the My Path booklet. Each member will also be asked to complete an anonymous survey including the Self-Reliance assessment results before they started the Group and at the completion of the Group . The facilitator will return to to record these surveys and complete a facilitator survey. Based on these surveys, additional information will be furnished to priesthood leaders on the overall success of Group members on their path to Self-Reliance After completion of the course and Registration of this data, inclluding the preparation of course completion certificates, this document should be destroyed to comply with data privacy if applies (last 12 months)Telepho