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Thank you for your interest in the Georgia Adolescent & Adult SANE/ SAFE Training offered by Mosaic Georgia 

This training is an intense didactic classroom program on the role of SANE/ SAFE services in Georgia. It is presented by a distinctly qualified multi-disciplinary faculty with demonstrated expertise in sexual assault victimization and the criminal justice system. Curriculum overview information is provided in the application packet.

IF YOU PLAN TO ATTEND THIS TRAINING:

Please submit an email as soon as possible to Training@mosaicga.org, and include your name, e-mail, telephone/cell contact information. Or, call: Miguel Montoya, Communications Specialist, at 770-497-9122 ext. 2021 for more information.

Please feel free to download the application below to begin.

2019 Training information will be posted soon.

Requirements

Required Documents Checklist

Complete and return forms:

  • Fee and Deposit Information Sheet – (2 pages)
  • GA SANE/SAFE Registration/Application Form – (2 pages)
  • Statement of Support and Signature Form – (3 pages)
  • Standards of Practice Agreement Signature Form – (“RN” or “PA; MD; DO” version, depending on status)
  • Criminal Background Check Consent Form
  • Emergency Contact Form

Required Attachments:

  • Copy of professional licensure as: RN; MD; DO; or PA
  • Copy of current professional liability insurance with term limits provided (as available)
  • A $25.00 check for Mosaic Georgia to run a criminal background report, along with the completed Background Check Consent Form. (Military can provide employment verification letter from supervisor.)
  • A separate check in the amount noted on the Fees and Deposits form, made payable to Mosaic Georgia.
  •  An enlarged copy of your current Driver’s License. (Please be sure photo and information is clear.)

Applicant Requirements

Registrants should be a licensed:

  •  Registered Nurse (RN)
  • Physician Assistant (PA)
  • Medical Doctor; Doctor of Osteopath (MD; DO)

Fees

Georgia Licensees (excluding correctional facility personnel)

  • Criminal History Report: $25
  • Course Fee: $0
  • Deposit (Refundable): $100

Military Out-of-State Licensure

  • Criminal History Report: $25
  • Course Fee: $200
  • Deposit (Refundable): $0

Non-Georgia Licensees & Georgia Correctional Facility Personnel

  • Criminal History Report: $25
  • Course Fee: $350
  • Deposit (Refundable): $0