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CEUCourse Approval Form

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Belen CR
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6 views2 pages

CEUCourse Approval Form

Uploaded by

Belen CR
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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OPERATOR CERTIFICATION

CONTINUING EDUCATION UNITS


COURSE EVALUATION

APPLICATION INSTRUCTIONS
1. In keeping with the privacy provisions of the Nova Scotia Freedom of Information & Protection of Privacy Act, Nova
Scotia Environment will only use personal information for the purpose for which the information was obtained or
compiled, or for a use compatible with that purpose.
2. Information regarding operator certification including continuing education units can be found on our website at:
http://novascotia.ca/wwoc. Refer to the Guideline for Water and Wastewater Operator Certification Certificate
Renewal for information specific to continuing education units.
3. Courses below 0.3 CEUs will not be assessed for pre-approval.
4. Upon successful completion of pre-approved courses, each attendee shall be provided with a signed certificate
which displays the course name, the number of CEUs assigned, and the date of the course.
5. Please send completed applications to: Operator Certification Administrator C/O Sandra Hartley, Nova Scotia
Environment, PO Box 442, 1894 Barrington St., Suite 1800, Halifax, NS B3J 2P8. Alternatively, you may fax to
(902) 424-1080 or Scan and email to [email protected].
6. Inquiries may be directed to 902-424-2553 or 902-225-5037.

APPLICANT CONTACT INFORMATION


NAME OF TRAINING PROVIDER CONTACT PERSON

MAILING ADDRESS CITY/TOWN/COMMUNITY

PROVINCE / STATE POSTAL CODE / ZIP CODE EMAIL

PHONE FAX WEBSITE

COURSE DESCRIPTION
NAME OF COURSE CONTACT HOURS (EXCLUDING BREAKS, REGISTRATION, MEALS)

LOCATION(S) OF TRAINING

TYPE OF INSTRUCTION (CHECK ALL THAT APPLY)

☐ Classroom ☐ In-house Training ☐ Correspondence ☐ Video ☐ Hands-on ☐ Other (specify) ________________


METHOD TO VERIFY LEARNING OUTCOMES BY PARTICIPANTS (CHECK ALL THAT APPLY)

☐ Exam (written/oral) ☐ Quiz ☐ Written Reports ☐ Demonstration ☐ Other (specify) ________________________

DECLARATION OF APPLICANT
I hereby certify with my signature that all information contained in this application is true and correct. I understand that any
omissions or misrepresentations may result in changes to the approved CEU value or removal of this course from the list
of pre-approved courses. I also accept that further information and course material may be requested for review.
SIGNATURE DATE

December 2021
CURRICULUM DETAILS
NAME OF COURSE

LEARNING OBJECTIVES

☐ Copy of learning objectives attached (optional)


TOPICS COVERED

☐ Copy of topics covered attached (optional)


TIMELINE

☐ Copy of agenda attached (required)


INSTRUCTOR CREDENTIALS (RELATED TO THE SUBJECT MATTER)

☐ Copy of instructor credentials attached (optional)

December 2021

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