SafeSport Program

USA Powerlifting SafeSport Program
Questions? Contact Adriana DaCosta at adacosta@usapowerlifting.com Do not email the National Office.

USA Powerlifting Membership Required.

If you are not currently a member, or if your membership has expired, please go to the USA Powerlifting website and submit your Membership Application prior to completing this form.
Name *

First Name Last Name
E-mail *
Phone Number: *

Area Code Phone Number
Mailing Address: *

Street Address

Street Address Line 2

City State

Zip Code
Birth Date: *

Month Day Year
Age: *
Sex: *
USAPL Membership # *
SafeSport Details
Referee *
Meet Director *
Coaching Level *
Other *
This Option is to only be used you do not fall into the Referee, Meet Director or Coaching Level options.
Safe Sport Course Completion Date *

Month Day Year
Completion Code: *
Can be found at the bottom of your Certificate.
You only need to upload the SafeSport Trained certificate from the last module, PDF format only!
Safe Sport Certificate *
Upload PDF format Only
Background check submissions to Verified Volunteers will occur twice weekly. Please submit your information and upload your SafeSport course certificate via this form no later than Monday at 5pm, EST and Thursday at 5pm, EST

By submitting this request, you are granting permission to USA Powerlifting to request a background check on your behalf. A separate email will be sent to you from Verified Volunteers, our vendor for background checks that will require you to respond to the email with the information required for them to complete the background check.
Background
SafeSport
Total
Background Check / SafeSport

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USA Powerlifting SafeSport Program

SafeSport Details