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MiTEC LMS Registration Form

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 Management System (LMS). This could take 24/48 hours. Please watch for an email with login information from MDHHS-MiTEC@Michigan.gov.
1.First & Last Name(Required.)
2.Email Address (This must be unique in the system)(Required.)
3.Mailing Address(Required.)
4.Cell Phone Number (This will be used for class reminders)(Required.)
5.Please enter BPI number (if applicable)
6.What is your Weatherization hire date? (This is the date hired to provide Weatherization work)(Required.)
Date (If not within WAP network, put today's date)
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)(Required.)
8.Contracting Company Name (N/A if not applicable)(Required.)
9.Information of Employer/Manager (Enter your own name if self-employed)(Required.)
10.Select all agencies you/your company is affiliated with. (Please note: MITEC will confirm affiliations)(Required.)
11.What program or industry are you working in? (Choose all that apply)(Required.)
12.What is your title or JTA if working in Weatherization.(Required.)
13.If you are a Contractor, what type are you? (Choose All That Apply)
14.Enter all certifications you currently hold(Required.)
15.Emergency Contact(Required.)
16.How many years have you worked in weatherization?
17.Who is your employer?