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NORTH CAROLINA DEPARTMENT OF TRANSPORTATION
MATERIALS AND TESTS UNIT

NCDOT COATING INSPECTION INFORMATION FORM

**REMEMBER TO ENCLOSE A CHECK WITH APPLICATION IF APPLICANT IS A NON DOT EMPLOYEE**

Required Fields*


Enrollment Information:

*Date:

*Name:

*Company:

Division/Unit (DOT):

DOT Cost Center:

PE Registration #:


Work Mailing Address:

*Street:

*City:       *Zip Code:

*Phone: Email:


General Information:

*Contact Person:  Email:

*Phone:

Experience with Coating:


*All registration forms must be submitted 30 days prior to school start date.
*The Non-refundable fee (payable to NCDOT Materials and Tests) and registration forms should be sent to the following:

NCDOT – MATERIALS AND TESTS UNIT
1801 BLUE RIDGE ROAD
RALEIGH, NC 27607
ATTN: COATINGS & CORROSION ENGR.



      



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