Application For Agricultural Operation Planning Certificate

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 is not authoritative. Please refer to www.e-laws.gov.on.ca or the official volumes printed by Publications Ontario for the authoritative text of the act.

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Note: Original signatures are required. Please complete the application form and submit by mail or in person. Please Print Clearly in Ink.

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Application for Agricultural Operation Planning Certificate

Section 1 – Applicant Information

Farm Name: ___________________________________________

Mailing Address (include 911, RR#):

_____________________________________________________

City/Town: ________________________ Postal Code:__________

Telephone: ( ) _________________ Fax: ( ) _________________

County/Regional Municipality: _____________________________

Email Address: __________________________________________

Name of Applicant (First, Middle, Last):

______________________________________________________

Section 2 – Requirements for Certification

Courses:

Regulation and Protocols	Location/Date: ______________________________
Fundamentals of Nutrient Management or Equivalency	Location/Date: ______________________________
Introduction to NMAN OR How to Prepare an NMS/P (Optional)	Location/Date: ______________________________

Please indicate any that apply:

Are you a CCA?	Indicate Number _______________________
Are you a P.Ag.?	Indicate Number _______________________
Other Professional Designation	Indicate Number _______________________

_________________________________
Date

_________________________________
Applicant's signature

 _________________________________
Applicant’s title (farm owner, manager)

Personal information is collected under the authority of the Nutrient Management Act, 2002, S.O. 2003, c.4 and O. Reg 267/03 as amended, s. 100. The information will be collected and used by the Ministry for: a) the support of certification and licensing requirements under the Nutrient Management Act, 2002, including future communications, plan approvals, monitoring and compliance, and b) will be added to an informational database. For information, contact the Manager, Training and Certification, Nutrient Management Branch, Ministry of Agriculture and Food, 519-826-6572. Note: In the future, the Certification and Registration registry may be maintained by a third party service provider.