Training/Hosting Request Form

Name of Facility *

Training Delivery Physical Address where training will be conducted (if applicable, include bldg. name or number)

Organization *

Organization Address *

Address Line 1

Address Line 2

City

State

Zip Code

Estimated number of students in class *

Primary Point of Contact for Class *

First

Last

Primary Contact's Email *

Primary Contact's Work Phone *

Primary Contact's Cell Phone *

Secondary Point of Contact for Class

First

Last

Secondary Contact's Work Phone for Class (if different than above)

Secondary Contact's Email for Class (if different than above)

Secondary Contact's Cell Phone for Class (if different than above)

Billing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Training/Hosting Course List

Select all that are of interest

Highway Safety

HWS002 – 16hr Work Zone Traffic Control
HWS005 – 6hr Work Zone Traffic Control Refresher
HWS410 – 16hr Work Zone Traffic Control for Contractor’s Responsible Person
HWS415 – 8hr Refresher Course for Contractor’s Responsible Person
HWS110 – 4hr Flaggers in Work Zones
HWS114 – 4hr Train-the-Trainer Flaggers

Commercial Driver License (CDL)

CDL110 – 16hr Entry Level Driver Training – Theory
CDL111 – 56hr Entry Level Driver Training – Range and Road Class A

Heavy Equipment

HEP002 – 32hr Introduction to Backhoe Operation
HEP003 – 32hr Advanced Backhoe Operation
HEP205 – 16hr Introduction to Motor Grader Operator
HEP208 – 32hr Intermediate Motor Grader Operator
HEP209 – 16hr Introduction to Loader Operator
HEP213 – 16hr Skid Steer Operator
HEP214 – 16hr Equipment Load and Tie Down
HEP273 – 8hr Forklift Operator
HEP274 – 8hr Forklift Operator Instructor

(We also do custom classes in HE with various hours and other equipment – such as Dozer, etc)

School Bus Driver

PPT001 – 32hr School Bus Driver Instructor
PPT002 – 24hr School Bus Driver Instructor Refresher

Comments:

Disclaimer:

The host is responsible for: (1) a classroom to accommodate participants, (2) comfortable seating, (3) a projection screen or wall, (4) instructor table with power strip and extension cord, (5) appropriate training equipment with fuel, (6) training field. TEEX registers all participants at the beginning of each class, but is not responsible for participant meals, lodging, or travel. Refreshments are at the discretion of the host