Application for NASM Plan Development Certificate

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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.

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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 - 83kb

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___ Application for new certificate

___ Application for renewed certificate

Current Certificate Number (if applicable): ________________________________

Section 1 - Applicant Information

Applicant Name:

__________________________________________________________________

Company Name (if applicable):

__________________________________________________________________

Mailing Address (include 911, RR #):

__________________________________________________________________

City/Town:

__________________________________________________________________

Province:

__________________________________________________________________

Postal Code:

__________________________________________________________________

Region/County:

__________________________________________________________________

Tel: _______________________________________________________________

Fax: _______________________________________________________________

E-mail: _____________________________________________________________

Section 2 - Requirements for Certification

Courses

___ Introduction to Nutrient Management or ___ Fundamentals of Nutrient Management

Location/Date: ________________________________________________

___ How to Prepare an NMS/P using NMAN

Location/Date: ________________________________________________

___ NASM Plan Developer's Course

Location/Date: ________________________________________________

___ Professionalism & Ethics Course (Optional)

Location/Date: ________________________________________________

Fictitious Plans

___ NASM Plan

ID #: _________________________________________________________

Review Date: __________________________________________________

___ NASM Plan

ID #: _________________________________________________________

Review Date: __________________________________________________

Please indicate any that apply:

CCA #: ________________________________________________________

P.Ag #: ________________________________________________________

Other Professional Designation: ____________________________________

Exam

Exam Date: ____________________________________________________

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 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, Food and Rural Affairs, 519-826-6572. 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).

___ Yes, I would like my company's name made publicly available through OMAFRA (e.g. OMAFRA website, regional distribution, written publications, information centre requests, etc).

Section 3 - Signature

Name (print):

__________________________________________________________________

Applicant's Signature:

__________________________________________________________________

Date: _____________________________________________________________

Applications must be submitted to:

Ministry of Agriculture, Food and Rural Affairs
Environmental Management Branch
Training, Education and Communications Unit
3rd Floor SE
1 Stone Road West
Guelph, Ontario N1G 4Y2
Tel: 1-866-242-4460
E-mail: nman.omafra@ontario.ca