NCDOT Materials & Tests Unit: Soils Laboratory: NCDOT Student Information Form

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HOME » TRAINING COURSES » NCDOT STUDENT INFORMATION FORM

NCDOT Student Information Form

NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
MATERIALS AND TESTS UNIT - SOILS LABORATORY

NCDOT STUDENT INFORMATION FORM

ONE FORM PER STUDENT

Student Contact Information:

Name:   Date:

Job Title:   Last 4 Digits:

Student Home Mailing Address:

Street:

City:   State:   Zip:

General Information:

Contact Person:   Email Address:

Resident District Engineer:   Division:

Mailing Address:

Street:

City:   State:   Zip:

Desired Class:

Check each class you wish to attend. Place the amount of fees in the Applied Application Fees box. Total application fees at the bottom of the table.

Check Here	Desired Class	Application Fee	Applied Application Fees
	ABC Sampling School	$50.00
	Borrow Pit Sampling School	$50.00
	Conventional Density School	$100.00
	Nuclear Safety Haz. Materials	No Charge	No Charge

Total of application fees for requested classes (amount of check):

Cost Center Number:

Have you ever been previously certified in any of the schools listed above? Yes No

If "YES", what is your HiCAMS Certification Number?

NOTE: Send the original student information sheet with a non-refundable application fee payable to:
NCDOT Materials and Tests Unit

Class sizes are limited. Submission of this form does not guarantee a slot in the desired class.

Mail completed form and check or money order to:

Mehdi Haeri, Soils Engineer
1801 Blue Ridge Road
Raleigh, NC 27607

If you have any additional questions please contact Mehdi Haeri or Jim Sawyer at (919) 329-4150.


		The North Carolina Department of Transportation