NCDOT Materials & Tests Unit: QMS Nuclear Density Certification/Re-certification Classes Enrollment Form

*At least one name, SSN and Cert. No. is required

Name: SSN: (last 4 digits) Certification No:
Name: SSN: (last 4 digits) Certification No:
Name: SSN: (last 4 digits) Certification No:
Name: SSN: (last 4 digits) Certification No:
Name: SSN: (last 4 digits) Certification No:

Class Location: Dates:

*Please include certification number if attending for re-certification.

*Submitted by: *Email Address:

*Phone Number:

$100 Fee Per Person: Check Number:

NCDOT Students Please Include NCDOT Cost Center:

Submit application and mail non-refundable application fees payable to:

Materials and Tests Unit
Soils Laboratory
1801 Blue Ridge Road
Raleigh, NC 27607
(919) 329-4150

NCDOT applications do not send this fee. NCDOT fees will be handled by Materials and Tests Unit and charged to the appropriate Division. All applications must be received (15) fifteen days prior to class starting date. Contact with the applicant from the M&T Unit will only be made if enrollment is denied.

Please ensure any technician you enroll in this training class has Satisfactorily completed Radiation Safety training as required by your Radiological License.


		The North Carolina Department of Transportation