Learning Management System (LMS) Registration Form

This survey will gather information that is sent to the MiTEC Student Services team to create a user account for you in the Learning Managment System (LMS). This could take 24/48 hours. Please watch for an email with login information from BCAEO-MiTEC@Michigan.gov.

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* 1. First & Last Name

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* 2. Email Address (This must be unique in the system)

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* 3. Mailing Address

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* 4. Cell Phone Number (This will be used for class reminders)

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* 5. Please enter BPI number (if applicable)

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* 6. What is your Weatherization hire date?

Date

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* 7. Are you employed by a Community Action Agency (CAA) or contractor to provide weatherization services? (If you are not affiliated with a CAA, you will be charged for training per DOE guidelines)

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* 8. Information of Employer/Manager (Enter your own name if self-employed)

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* 9. Select all agencies you/your company is affiliated with. (Please note: MITEC will confirm affiliations)

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* 10. What program or industry are you working in? (Choose all that apply)

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* 11. What is your title or JTA if working in Weatherization.

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* 12. If you are a Contractor, what type are you? (Choose All That Apply)

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* 13. Enter all certifications you currently hold

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* 14. Emergency Contact

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* 15. How many years have you worked in weatherization?

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* 16. Who is your employer?

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