Application for Agricultural Operation Strategy/Plan Development CertificateThe 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 - 91 KB ____ Application for new certificate ____ Application for renewed certificate Current Certificate Number (if applicable): _______________________________ Expiry Date (if applicable): _______________________________ Section 1 – Applicant InformationApplicant Name: ___________________________________________________ Company Name (if applicable): ________________________________________ Home Mailing Address (include 911, RR #): ___________________________________ _________________________________________________________________ City/Town: ________________________________________________________ Province: _________________________________________________________ Postal Code: ______________________________________________________ Region/County Covered: ____________________________________________________ Tel: ______________________________________________________________ Fax: ______________________________________________________________ E-mail: ____________________________________________________________ Section 2 – Requirements for CertificationCourses ____ Introduction to Nutrient Management Location: ___________________________________________________________ Date: ______________________________________________________________ ____ Regulation and Protocols Location: ___________________________________________________________ Date: ______________________________________________________________ ____ How to Prepare an NMS/P Using NMAN Location: ___________________________________________________________ Date: ______________________________________________________________ Nutrient Management Strategies and Plans (NMS/P) ____ Fictitious NMS/P #1 ID # _______________________________________________________________ Review Date: ________________________________________________________ ____ Fictitious NMS/P #2 ID # _______________________________________________________________ Review Date: ________________________________________________________ ____ Fictitious NMS/P #3 ID # _______________________________________________________________ Review Date: ________________________________________________________ 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. For information, contact the Agricultural Information Contact Centre, Ministry of Agriculture, Food and Rural Affairs, 1-866-242-4460 or nman.omafra@ontario.ca. Note: In the future, the certification and registration registry may be maintained by a third party service provider. ____ Yes, I would like my name made publicly available through OMAFRA (e.g. OMAFRA website, regional distribution, written publications, information centre requests, etc). Section 3 – SignatureDeclaration I hereby declare that, 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 to obtain the Agricultural Operation Strategy/Plan Development (AOSPD) Certificate. Name (print): _______________________________________________________ Applicant's Signature: ________________________________________________ Date: _____________________________________________________________ CCA#: _______________________ (if applicable) Applications must be submitted to: Environmental Management Branch
For more information: Toll Free: 1-877-424-1300 Local: (519) 826-4047 E-mail: ag.info.omafra@ontario.ca
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