If you did not attend with a Group DO NOT SUBMIT THIS FORM.

Supervisor/Training Administrator: Please Complete this Form in its Entirety.

Please Submit within 24 Hours

*Questions with an Asterisk must be completed.

Any questions please contact the MSI Helpline 866-661-5120.

Question Title

1. Select the MSI Live Course Title: (Required.)

Question Title

2. Date and Start Time of the Course: (Required.)

Date
Time

Question Title

3. Agency (Employer): (Required.)

Question Title

4. Department: (Required.)

Question Title

5. Supervisor Information (Please complete all fields) (Required.)

Question Title

6. If you have a Water/Wastewater License # please enter it below:

Question Title

7. Did you attend the training? (Required.)

Question Title

8. For Supervisor:
"I attest the submitted participants attended the entire course and were given the opportunity to ask questions about the material." (Required.)

Question Title

9. Registered Name (Zoom): (Required.)

Question Title

10. Did you attend the training? (Required.)

Question Title

11. Number of Participants that attended the Training (Number Only): Please Complete the Participants Information on the "NEXT PAGE" by Clicking the the Green Button Below. Thank you (Required.)

Page1 / 2
 
 50% of survey complete.

T