CERTIFICATION OF COMPLETION OF
QUALIFYING PREMARITAL EDUCATION
This will certify that ___________________________ and __________________________ have completed a course of premarital education conducted by the undersigned on ____________________ [Date] and that such course qualifies under Section 19-3-30.1 of the Official Code of Georgia Annotated in that it included at least six hours of instruction involving marital issues (which may include but not be limited to conflict management, communication skills, financial responsibilities, child and parenting responsibilities, and extended family roles) and the couple underwent the course together.
I further certify that I am
____ A professional counselor, social worker, or marriage and family therapist who is licensed pursuant to Chapter 10A of Title 43 of the Official Code of Georgia Annotated;
____ A psychiatrist who is licensed as a physician pursuant to Chapter 34 of Title 43 of the Official Code of Georgia Annotated:
____ A psychologist who is licensed pursuant to Chapter 39 of Title 43 of the Official Code of Georgia Annotated;
____ An active member of the clergy who:
___ performed such education in the course of my service as clergy; OR
___ designated ___________________________ to perform such education, and I certify that my designee is trained and skilled in premarital education and has certified to me the completion of the course by the couple.
Sworn to and certified before me ___________________________________
on ____________________. Signature
___________________________ ___________________________________
Notary Public Printed Name
___________________________________
Address
___________________________________
City, State, ZIP