Form Mde/wma/bww/trn - Application For Training Program Approval
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2MARYLAND DEPARTMENT OF THE ENVIRONMENT
1800 Washington Blvd
Baltimore, Maryland 21230
(800) 633-6101x3167
(410) 537-3167
(410) 537-3168 (fax)
MARYLAND BOARD OF WATERWORKS AND WASTE SYSTEMS OPERATORS
APPLICATION FOR TRAINING PROGRAM APPROVAL
1) TRAINING PROGRAM:
COURSE CODE: ________________________
Title: _______________________________________________________________________________________________
__
__
__
__
Type of Program:
On-The-Job
/__ /
Home-study /__ /
Academic /__ /
Laboratory /__ /
__
__
Technical Part of Operator/Superintendent Mtg. /__ /
Other /__ / Describe briefly if Other" ______________________
Location(s) _______________________________ Dates and Times of Program (Please specify) _____________________
Will program be repeated after these dates and times? yes ____ no ____
Total Contact Hours of Training ___________
Final Exam Given? yes ____ no ____
Course Meets 50 % Process Control Rule (YES) _____
(NO) _____ (Check one)
2) APPLICANT:
Name _____________________________________________ Telephone No. ___________________________________
Address ____________________________________________________________________________________________
__
__
__
Status:
Training Sponsor /__ /
Instructor /__ /
Student /__ /
Signature: ______________________________________________________________________
3) TRAINING COURSE SPONSOR (If different from applicant):
Name ______________________________________________ Telephone No. __________________________________
Address ____________________________________________________________________________________________
4) CERTIFICATION CLASSIFICATIONS TARGETED. Note: Request For Operator And/Or Superintendent.
Superintendent Approval Must Be Checked Separately. Please Check Those That Apply.
OPERATORS
SUPERINTENDENTS
Wastewater Treatment
1 2 3 4 5 6 S A
Wastewater Treatment
Industrial Wastewater
1 2 3 4 5 6 7
Industrial Wastewater
Water Treatment
1 2 3 4 5 G
Water Treatment
Wastewater Collection
1 2
Wastewater Collection
Water Distribution
1
Water Distribution
ALL
ALL
[5958]
MDE/WMA/BWW/TRN
1 of 2
Revision Date (3/06)
Recycled Paper
TTY Users 1-800-735-2258
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Parent category: Business