WWW Training/Hosting Request

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

WWW Training/Hosting Course List

Select all that apply

Water

WWW001 Basic Water Works Operation
WWW002 Groundwater Production
WWW003 Water Distribution
WWW004 Surface Water production I
WWW006 Water Laboratory
WWW007 Water Technology
WWW013 Surface Water Production II
WWW019 Customer Service Inspector/Cross Connection Control

Wastewater

Water/Wastewater – Dual Credit

BPAT

WWW500 Backflow Prevention Assembly Tester
WWW501 BPAT Refresher: Rules and Regulations
WWW502 BPAT 16 hour Continuing Education
WWW504 BPAT Practical Skills (Hands-On)
WWW505 BPAT 24 hour Continuing Education

OSSF

WWW301 OSSF-Homeowner Aerobic Treatment & Surface Appl. System Operation and Maintenance
WWW302 OSSF Installer I
WWW303 OSSF Installer II
WWW304 OSSF Site Evaluator
WWW305 OSSF Designated Representative

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.