Pesticides Section

Application For Continuing Certification Credit Approval
*All Fields Are Required*

Date of Training:
Sponsoring institution or agency:
Contact person:
First Name: Last Name:

Mailing address of contact person:

EMAIL Address:
(must include email address to receive your confirmation)
P.O. Box or Street Address:
City:
County:
State: Zip:
Phone: ( ) Must Include Area Code:
Is this training open to the public? Yes *   No *
*If yes, it will be posted to the Pesticide Section's website.
Also, if you answer yes, go to the Training Calendar the following week on FRIDAY for confirmation of approval.

If No, specify any restrictions:

Location(s) of training:
Street Address:
City: County: (for NC only)
State:
Time training will begin: AM PM Format times in this manner... 12:00
Time training will end: AM PM Format times in this manner... 12:00
Title of training:
Please submit a detailed agenda including times of subject matter to be covered.
(you can copy & paste this info here from other formats or documents)
Length of time (hours)
directly related to pesticide
recertification credits:
This training is considered appropriate for Continuing Certification Credit in the following certification subclass or subclasses (check the square corresponding to the subclass code(s).
A. Aquatic K. Ag Pest - Animal P. Aerial Methods
B. Public Health L. Ornamental & Turf T. Wood Treatment
G. Forest M. Seed Treatment D. Dealer
H. Right-of-Way N. Demonstration & Research V. Private- Recert/Safety Class
I. Regulatory O. Ag Pest - Plant X. Private-Specialty Training
    All Subclasses except P and V

Instructor's Information:
Instructor's Name
Instructor's Title
Instructor's Education
Employed By*
*If not employed by Cooperative Extension Service or a Land-Grant Institution, a resume must be sent to verify qualifications.

*You may email the document here
2nd Instructor's Name
2nd Instructor's Title
2nd Instructor's Education
Employed By*
*If not employed by Cooperative Extension Service or a Land-Grant Institution, a resume must be sent to verify qualifications.

*You may email the document here
3rd Instructor's Name
3rd Instructor's Title
3rd Instructor's Education
Employed By*
 

*If not employed by Cooperative Extension Service or a Land-Grant Institution, a resume must be sent to verify qualifications. *You may email the document here

Training Materials:
Title:
Type: (Video, Slides, etc.)
Prepared or Distributed By:

I plan to prepare and submit the attendance roster using the Scanner & Database Program.

I plan to prepare and submit the attendance roster using the Online Method .

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Steve Troxler, Commissioner of Agriculture