Ag Inputs Course Sponsor Application Course Sponsor ApplicationIf you have any questions about this procedure, you may contact our office at (404) 656-4958 or email your questions to agpest@agr.georgia.gov Upon consideration and approval by the Ag Inputs Pesticide Program Manager, notification thru Kelly Solutions, along with Log in details will be emailed to the applicant. All application requests for course credit approval should be submitted online once approved. Name First Last Phone Organization Website Email Address Address City/Town State/Province - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ZIP/Postal Code Primary Purpose of Organization Will the courses be offered to the general public, or will they be limited to internal training for your employees only? What is the general plan for instructors? For example, will instruction be provided by extension agents or specialists, chemical company representatives, or other professionals? What categories will you plan to host or instruct in? (mark all that apply) Category 10 - Private Applicator Category 10 - Private Applicator Category 21 - Plant Agriculture Category 21 - Plant Agriculture Category 22 - Animal Agriculture Category 22 - Animal Agriculture Category 23 - Forestry Category 23 - Forestry Category 24 - Ornamental and Turf Category 24 - Ornamental and Turf Category 25 - Seed Treatment Category 25 - Seed Treatment Category 26 - Aquatic Category 26 - Aquatic Category 27 - Rights-of-Way Category 27 - Rights-of-Way Category 31 - Public Health Category 31 - Public Health Category 35 - Industrial, Institutional, Structural, and Health Related Category 35 - Industrial, Institutional, Structural, and Health Related Category 36 - Wood Treatment Category 36 - Wood Treatment Category 37 - Microbial Pest Control Category 37 - Microbial Pest Control Category 38 - Ag Commodity Fumigation Category 38 - Ag Commodity Fumigation Category 39 - Antifoulant Paints Category 39 - Antifoulant Paints Category 41 - Mosquito Control Category 41 - Mosquito Control Signature of Applicant Sign above Date CAPTCHA
Course Sponsor ApplicationIf you have any questions about this procedure, you may contact our office at (404) 656-4958 or email your questions to agpest@agr.georgia.gov Upon consideration and approval by the Ag Inputs Pesticide Program Manager, notification thru Kelly Solutions, along with Log in details will be emailed to the applicant. All application requests for course credit approval should be submitted online once approved. Name First Last Phone Organization Website Email Address Address City/Town State/Province - Select - Alabama Alaska American Samoa Arizona Arkansas Armed Forces (Canada, Europe, Africa, or Middle East) Armed Forces Americas Armed Forces Pacific California Colorado Connecticut Delaware District of Columbia Federated States of Micronesia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Marshall Islands Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Northern Mariana Islands Ohio Oklahoma Oregon Palau Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ZIP/Postal Code Primary Purpose of Organization Will the courses be offered to the general public, or will they be limited to internal training for your employees only? What is the general plan for instructors? For example, will instruction be provided by extension agents or specialists, chemical company representatives, or other professionals? What categories will you plan to host or instruct in? (mark all that apply) Category 10 - Private Applicator Category 10 - Private Applicator Category 21 - Plant Agriculture Category 21 - Plant Agriculture Category 22 - Animal Agriculture Category 22 - Animal Agriculture Category 23 - Forestry Category 23 - Forestry Category 24 - Ornamental and Turf Category 24 - Ornamental and Turf Category 25 - Seed Treatment Category 25 - Seed Treatment Category 26 - Aquatic Category 26 - Aquatic Category 27 - Rights-of-Way Category 27 - Rights-of-Way Category 31 - Public Health Category 31 - Public Health Category 35 - Industrial, Institutional, Structural, and Health Related Category 35 - Industrial, Institutional, Structural, and Health Related Category 36 - Wood Treatment Category 36 - Wood Treatment Category 37 - Microbial Pest Control Category 37 - Microbial Pest Control Category 38 - Ag Commodity Fumigation Category 38 - Ag Commodity Fumigation Category 39 - Antifoulant Paints Category 39 - Antifoulant Paints Category 41 - Mosquito Control Category 41 - Mosquito Control Signature of Applicant Sign above Date CAPTCHA
