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Application for Agricultural Operation Strategy/Plan Development Certificate

Author: Vicki Lass - Education and Training Coordinator/OMAFRA
Creation Date: 30 September 2004
Last Reviewed: 15 January 2008
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 completed the application form and submit by by mail or in person. Please Print Clearly in Ink.

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Application for Agricultural Operation Strategy/Plan Development Certificate

 

Section 1 – Applicant Information

Company Name: ___________________________________________________________________

Name of Owner: ____________________________________________________________________

Mailing Address (include 911, RR#): __________________________________________

City/Town: _____________________________________ Postal Code: _______________________

Telephone: (      ) ___________________________ Fax: (      ) ___________________________

County/Regional Municipality: _____________________________________________________

E-mail Address: ______________________________________________________


Section 2 – Requirements for Certification

Courses:

checkbox Regulation and Protocols Location/Date_____________________________
checkbox Fundamentals of Nutrient Management Location/Date_____________________________
checkbox Introduction to NMAN OR
checkboxHow to Prepare an NMS/P
checkboxProfessionalism & Ethics Course (Optional)		 Location/Date_____________________________

Fictious Plans:

checkbox NMS/P ID # _______________ Review Date ______________________
checkbox NMS/P ID # _______________ Review Date ______________________
checkbox NMS/P ID # _______________ Review Date ______________________

Please indicate any that apply:

checkboxAre you a CCA? Indicate Number _______________________
checkboxAre you a P.Ag? Indicate Number _______________________
checkboxOther Professional Designation  

Exam:

checkboxExam Date: _________________________ Grade Received: _______________

Additional Information

checkboxYes, I would like my name made publicly available through OMAFRA. (e.g. OMAFRA web site, regional distribution, written publications, information centre requests, etc.)

____________________________ Date__________________________
(Applicant's signature)

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.

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E-mail: nman.omafra@ontario.ca