NCDOT Materials & Tests Unit: Concrete School Student Information Form

	SEARCH!

NC DOT

NC DOH

NC GOV


		ONLINE NAVIGATION

M&T Work Groups

Administration

Asphalt Laboratory

Chemical Laboratory

Compliance & Assurance

Material Operations

Physical Testing Laboratory

Quality Assurance

Soils Laboratory

Structural Members

2008 Training Schedule

Approved Lists

Electronic Forms

Minimum Sampling Guide

Online Standards

HiCAMS Information

HiCAMS Homepage

HiCAMS M&T FAQs

Links

AASHTO-SOM

ASTM

ACI

SSPC

AWS

TCCC

HOME

NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
MATERIALS AND TESTS UNIT – CONCRETE SCHOOL

NCDOT CONCRETE STUDENT INFORMATION FORM
**Form must be filled out completely and payment must accompany form or it will be returned to sender**

Required Fields*

Enrollment Information:

*First Name: *Last Name:

*Date: *Job Title: *Last 4 Digits:

Student Home Mailing Address:

*Street:

*City: *State: *Zip Code:

General Information:

*Contact Person: *Email:

*Resident / District Engineer: *Division:

*(Non-DOT) Supervisor: *Company:

Mailing Address:

*Street:

*City: *State: *Zip Code:

Concrete Field Technician Registration – Maximum 3 seats per location
              No. of Seats:                                School Date:                                School Location:

NCDOT CERTIFICATION ONLY
MUST CURRENTLY BE ACI CERTIFIED AND INCLUDE A COPY OF CERTIFICATION
   Name(First-Middle-Last):                     School Date:                                School Location:

ACI RETEST
MUST INCLUDE DATE & LOCATION OF ORIGINAL FIELD TECH. SCHOOL
   Name(First-Middle-Last):                     School Date:                    Location Orig. Field Tech. School:

FIELD PERFORMANCE RETEST
MUST INCLUDE DATE & LOCATION OFORIGINAL FIELD TECH. SCHOOL
   Name(First-Middle-Last):                     School Date:                    Location Orig. Field Tech. School:

BATCH/MIX DESIGN
MUST BE “FIELD CERTIFIED” TO ATTEND BATCH
MUST BE “FIELD CERTIFIED” AND “BATCH CERTIFIED” TO ATTEND MIX DESIGN
            Name(First-Middle-Last):                (Batch/Mix)       School Date:         Location:       NCDOT Cert. No.:

SELF STUDY – THERE WILL BE NO REVIEW FOR THIS COURSE, EXAMS ONLY!
            Name(First-Middle-Last):               School Date:         Location:       NCDOT Cert. No.:

School:	No. of Seats:	Price Per Seat:	Total:
Concrete Field Tech.		$250.00
NCDOT Cert. Only		$100.00
ACI Retest		$100.00
Field Performance Retest		$50.00
Batch Tech.		$100.00
Mix Design Tech.		$250.00
Self Study		$250.00

Note:

*All registration forms must be submitted 30 days prior to school start date.
*Registration through Vendor System available for NCDOT Personnel. (Do not send form if registering through Vendor System.)
*The Non-refundable fee (payable to NCDOT Materials and Tests) and registration forms should be sent to the following:

NCDOT – MATERIALS AND TESTS UNIT
1801 BLUE RIDGE ROAD
RALEIGH, NC 27607
ATTN: WALTON JONES


		The North Carolina Department of Transportation