By including my signature below, I authorize NATE to transfer my test results and certification information to

I confirm that the details I entered are correct

I confirm that the details I entered are correct

I confirm that the details I entered are correct

I confirm that the details I entered are correct

I confirm that the details I entered are correct

This information requested below and any documentation regarding your disability and your need for accommodations in testing will be considered strictly confidential and will not be shared with any outside source without your express written permission.

Accommodations requested for NATE Certification Testing:

PLEASE CHECK ALL THAT APPLY:

Accessible Exam Site
Braille
Large Print
Tape
Reader (choose one)
for visual impairment
for learning disability
Scribe (choose one)
for visual impairment
for learning disability
Extended Time
Separate Testing Area
Other Accommodations (specify)

I understand that I must forward all required paperwork with this document at least 45 days prior to my exam
date in order to be processed.

I confirm that the details I entered are correct

NATE DOCUMENTATION OF DISABILITY RELATED NEEDS

If you have a learning disability, a psychological disability, or other disability that requires an accommodation in testing, please have this form completed by an appropriate licensed professional (psychologist, physician, or surgeon) to certify that your disabling condition that requires the requested exam accommodation. If you have existing documentation of having the same or similar accommodation provided to you in another test administration you may submit such documentation instead of having this form completed.


If you have existing documentation of having the same or similar accommodation provided to you in another test administration you may submit such documentation instead of having this form completed.

This form must be returned in order to process exams in a timely matter. Please complete all fields.

GENERAL INFORMATION

Please list any assistant proctors, translators, or readers who assisted in the session:

TEST SESSION COMMENTS

EXAM INFORMATION:

Ship testing materials (via trackable method) to:
North American Technician Excellence
Attn: Exam Processing
2311 Wilson Blvd., Suite 410, Arlington, VA 22201

I certify the testing materials returned with this form were reviewed by me and/or any assistant proctors.

North American Technician Excellence (NATE) requires technicians to complete 16 continuing education hours (CEHs) every 2 years in order to recertify by CEHs. Training must be relevant to the specialty or in general topics such as safety, electricity, controls, codes and regulations. Proof of training is accepted in the form of a certificate of attendance or roster from the training provider.
This form can be completed by the technician and the instructor in the absence of these documents and submitted via email to recertify@natex.org or fax at 571-282-0973. Call NATE customer service at 877-420-6283 for assistance.
Important: Credit will not be given if the form is incomplete. Only include a course number for NATErecognized courses. If the course is not recognized by NATE, a brief course outline must be included.

CONTACT INFORMATION

TECHNICIAN




INSTRUCTOR

COURSE DETAILS

TRAINING COURSE

COURSE OUTLINE

Have multiple technicians taking this course? Save time and call to find out about getting it NATE-recognized!
Provide details of the course content here:

SIGNATURES

Technician consent
Instructor consent

Company Name:
Requestor Name:*
Business Adress:*
Telephone #*
Requestor Email Address*
Company Email Address*
Type of Logo Request*ContractorTesting ProviderTraining ProviderTraining and Testing ProviderHVAC Equipment ManufacturerWholesaler/DistributerUtilityOther
Color Scheme*ColorBlack and White
Type of Logo Required*.JPEG.EPS (vector)
Name of Technician with NATE Certification*
Technician's NATE ID Number:*
TO
RTP
I confirm that the details I entered are correct