MSHA Training Course Registration Form

Train the Trainer Waitlist & Application Submission Form

You must have a MIIN number before applying. If not, please go to this site to request one: https://egov.msha.gov/MIIN/MIIN.aspx. As well as having the application complete with all required documentation.
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. We must have at least 6 people to provide/schedule the course. Please call 575-835-5460, or email our current administrative specialist for any questions.

Please see our site for requirements and instruction. https://www.nmt.edu/research/organizations/mines/train-the-trainer.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
Are you an individual taking this course or taking it through a company?
How many people will attend the class? (If you are a company, list 1 if individual)*
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
The check off the each required document that you are going to upload. These must be submitted in order to be approved to take the course.*

Application(s)5000-23 for New Miner or Annual Refresher: 3+ years (to show mining experience).Resume (must list experience and any classes you have taught or helped with).Certifications for any training you have received: Equipment, Mining, Safety, Instructor, OSHA, CMSP, ASSE, etc.
Please upload everyone's application(s) if you are a company. Individuals not with a company will upload their own.

Following applications types: Train the Trainer/Blue Card
Cancelof

Company or Individual Information

We will contact you as soon as the applications are approved to take the class, or if something is missing.
Company Name / Individual Name*
Mine ID Number (Company) / MIIN Number (Individual) *
Please put N/A if this does not apply.
Point of Contact Name*

First NameLast Name
Phone Number*
Please enter a valid phone number.
Email Address*
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

Payment for TTT Class

,
Payment will need to be made in advance. The class is $400 per person with refunds available up to one week prior for cancellation. There is an additional $200 administration fee for cancellations made less than 5 days before this scheduled class.

The payment site is on our TTT page, but you can scan the QR code below to make a payment or go to: https://secure.touchnet.com/C22533_ustores/web/product_detail.jsp?PRODUCTID=684
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Train the Trainer Waitlist & Application Submission Form