State License Renewal Request

State License Renewal Request
This form is to be completed by the following classifications only:
- Inside Journeyman Wireman
If you would like to request a certificate of completion for a training class you took at the apprenticeship, please complete the following form and someone will reach out to you. You will receive either a certificate with your CEU's or a letter on our letterhead verifying the classses and hours you completed. Please complete a section for each class you are requesting hours for below. We will only send certificates for classes listed below.

*Please allow 72 hours for the office to process your request.*
Today's Date

MonthDayYear
Date
Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
How would you like to receive your certificates?*

Please email them to me.Please print them for me and I will pick the up from the front desk.
Name of class 1 completed*
For example: transformers, motor control, code...
Year class 1 was completed (YYYY)*
For example: 2024
How many hours did you attend for class 1? (Please total the hours in the box below)*
Name of class 2 completed
For example: transformers, motor control, code...
Year class 2 was completed (YYYY)
For example: 2024
How many hours did you attend for class 2? (Please total the hours in the box below)
Name of class 3 completed
For example: transformers, motor control, code...
Year class 3 was completed (YYYY)
For example: 2024
How many hours did you attend for class 3? (Please total the hours in the box below)
Name of class 4 completed
For example: transformers, motor control, code...
Year class 4 was completed (YYYY)
For example: 2024
How many hours did you attend for class 4? (Please total the hours in the box below)
Name of class 5 completed
For example: transformers, motor control, code...
Year class 5 was completed (YYYY)
For example: 2024
How many hours did you attend for class 5? (Please total the hours in the box below)
Please upload a copy of your state license if you have it.

If you do not need to upload paystubs because you have the hours via TradeSchool hours, leave this section blank.
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Additional Comments
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