S&H Certificate Application Form

For questions regarding the certificate application, please call 800-326-7568

Student ID:
	First 4 letters of your last name (use X to fill leftover blanks)	Month and day of your birthdate: MMDD
Please select the certificate for which you are applying: If you wish to apply for more than one certificate, please fill out a separate application

Safety & Health Construction Specialist
Safety & Health General Industry Specialist
Disaster Site Worker Safety & Health Certificate
Safety & Health Leadership Certificate

Name:
Title:
Organization:
Address:
City:
State:
Zip:
Phone:
Fax:
E-mail:

What certifications, degrees or work-related training do you have?

Yes! I am interested in subscribing to the ENVHLTHCE Listserv!

For more information on the DEH CE program, please contact our office.
Northwest Center : (206) 543-1069
OSHA Training Institute : (206) 685-3089 or (800) 326-7568
Fax: (206) 685-3872
Email:ce@u.washington.edu
This page was lasted edited on .