Application for Nutrient Application Technician Licence

---

The information contained in this document is derived from the Nutrient Management Act, 2002 and O. Reg 267/03 as amended. Every effort has been made to make it as accurate as possible, but is not authoritative. Please refer to the e-Laws website or the official volumes printed by Publications Ontario for the authoritative text of the act.

---

Note: Original signatures are required. Please type or print clearly in ink. Please complete the application form and submit by mail or in person. Do not fax. Signature and contact information are on page two.

PDF Version - 93 KB

---

____ Application for new licence

____ Application for renewed licence

Current licence Number (if applicable): ___________________________________

Expiry Date (if applicable): ______________________________________

Section 1 – Applicant Information

Applicant Name: _____________________________________________________

Home Mailing Address (include 911, RR #): _____________________________________

___________________________________________________________________

City/Town: __________________________________________________________

Province: ___________________________________________________________

Postal Code: ________________________________________________________

Tel: _______________________________________________________________

Fax: _______________________________________________________________

E-mail: _____________________________________________________________

___________________________________________________________________

Section 2 – Requirements for Licencing

____ Nutrient Application Technician Licence e-Learning Course or ____ Nutrient Application Technician Licence Course classroom OMAFRA facilitated or ____ Prescribed Materials Application Business Licence Course

Location: ___________________________________________________________

Date: ______________________________________________________________

Exam Information

Exam: _____________________________________________________________

Exam Date: _________________________________________________________

Exam Location: ______________________________________________________

Grade Received: _____________________________________________________

Additional Information

Personal information is collected under the authority of the Nutrient Management Act, 2002, s. 32. The information will be collected and used by the Ministry or their agents for: a) the support of the certification and licensing program under the Nutrient Management Act, 2002, including future communications, research, training, certification, program development, plan approvals, monitoring and compliance, and b) will be added to an informational database. Note: The certification and registration registry may be maintained by a third party service provider. For questions about the collect6ion of this information, call 1-888-466-2372 x66374

Section 3 – Declaration for the E-learning Option

I participated in the e-learning option and verify that I have fully completed the course, including the following elements:

____ viewed all chapters of the Nutrient Application Technician e-learning course

____ completed and passed all exercises in the e-learning course

____ discussed all questions in the "Talk to your Employer" section with my employer

 

Section 4 – Signature

Declaration

I hereby declare, to the best of my knowledge, all information I have provided in this form is complete and accurate. I further hereby declare that I have completed the training and testing requirements as required by OMAFRA to obtain the Nutrient Application Technician Licence.

Signature: ___________________________________________

Date: _______________________________________________

Submit Application to:

Environmental Management Branch
Ministry of Agriculture, Food and Rural Affairs
Training, Education and Communications Unit
3rd Floor SW
1 Stone Road West
Guelph, Ontario N1G 4Y2
Tel: 1-866-242-4460