3.

End of Group Report and Certificate Request Form

The Church of Jesus Christ of Latter-day Saints (“the Church”) collects this information in order to (1) provide you with support as you participate
in a self-reliance group and share your progress with your ecclesiastical leaders, and (2) track your progress so you can receive your completion
certificate. 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 me to update it. Your information will be used in
accordance with the Church’s records management and confidentiality policies that can be viewed at lds.org/legal/privacy.
Instructions for Group Facilitator or Other Leader
1. Read the paragraph above to group members at the last group meeting. Complete this form, and then enter the information online at srs.lds.org/report as soon as possible. If you
need help entering the information online, ask a member of the stake or district self-reliance committee to help you. Make sure that each group is reported only once.
2. After submitting the information, you will receive a confirmation email, and your local self-reliance manager will process your certificate request.
Group Information
Stake or district Type of group Date of last group meeting
Villa Mitre Bahia Blanca English Connect 1 16 Octubre 2020

Group facilitator name Group facilitator email Group facilitator phone

Gabriela Rossi gabyariana@hotmail.com 0291-154486901

Group Members Answer all questions below.

Full name Stopped
Started or Started an Started or
attending Got a Earne
(Write down all group members that improved a educationa improved a Ward or branch Phone (with area code) E
before the new or da
were registered at the beginning of business? l program? budget? m
end of the better certificat
the group.) ail
group? job? e?*

Roberto Andrés Riveros □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

Villa Mitre 2 2914642383 Riverosroberto858@gmail.co
m
No No No No No No
Luciana Maribel Pitto □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □
Villa Mitre 2 2914313732

Robles No No No No No No

Rita Zulma Lobier

Villa Mitre 2 2914124933 hadasdeensuenio@hotmail.co
□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ m
No No No No No No
Maria del Rosario Alvarez □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □
Villa Mitre 2 2915005649 maryalvarez2355@mail.com
No No No No No No

Nayla Sol Melgarejos

Villa Mitre 1 2915084418 melgarejosnayla0@gmail.com
□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □
No No No No No No

Mariela Edith Oyarzún

Villa Mitre 1 2916457423 marioyar@hotmail.com
□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □
No No No No No No

Nora Zulema Luna

Barrio Hospital(Estaca Bahia 2914024273 soyrefama@hotmail.com
□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ Blanca)
No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

No No No No No No

□ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □ □ Yes □

 No No No No No No
*Certificate requirements are at the end of each group manual.

© 2016, 2018 by Intellectual Reserve, Inc. All rights reserved. 7/18. PD60001477