MSHA Training Course Registration Form

Coal Mine Foreman Certification Form

Please fill out the form to be put on a waitlist.
We will have a date and location posted when an exam session is available. Please call 575-835-5460

Please see our site for instruction. https://www.nmt.edu/research/organizations/mines/certifications.php
Course Information
Please select the needed exam (If you have not filled out an application, please do not continue this form, and missing info will automatically be denied until all documentation has been received).*
Please download your applications and see the requirements and application instructions at: https://www.nmt.edu/research/organizations/mines/certifications.php
How many people will attend the class? *
Class minimum is 6 people. If there will be less then 6, we are required to charge for 6 people. Small classes (5 or less) will have to held at our location.
Please list the names of the attendees*

Submit Application(s) & Required Documentation
Please upload everyone's applications if you are a company. Individuals not with a company will upload their own.

Following applications types: Underground Foreman, Underground Examiners, General Underground, Coal Mine Foreman, Surface Foreman, and Recertification.
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Company Information

We will contact you as soon as the applications are approved.
Company Name/Individual Name*
Mine ID Number *
Please put N/A if this does not apply.
Point of Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
We are looking to start electronically sending invoices. What is the best email to send them to?*
example@example.com
Mailing Address *

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
Are the mailing and physical address the same?*
If yes, skip next question.
Physical Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code

The invoice will be processed once the class has taken place. Please ensure that your attendees fill out the sign-in sheet clearly. You can scan the QR code below to make a payment upon receiving invoice.

You may make a pre payment, just call 575-85-5460 and we can give the invoice number ahead of time.
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Coal Mine Foreman Certification Form