Please complete this PCI/Ecology College Online training application by neat printing and legible black ink, along with your signature, and scan and send to PCI by email attachment to:  moldconsultant@yahoo.com.

Full name:________________________________________________________________________

Mailing address:___________________________________________________________________

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City:__________________________________ State: ________________  Zip Code: ___________

Country:___________________________  Daytime phone: (________ )______________________ 

Evening phone: (_______)_______________  Email:______________________________________

Designation [s] I desire [upon successful completion of each certification designation training program]---:
     ____ Certified Mold Inspector and Certified Mold Remediator - tuition is only US$998 for both PCI professional designation certifications Certified Mold Inspector and Certified Mold Remediator, plus US$198 first year PCI certification membership dues total for both   designations, for a total of US$1,196. Non-refundable.
     ____ Certified Environmental Hygienist [combined training and designation]. The certification program is only U.S. $999, plus $99 per year certification membership dues in the Professional Certification Institute. Non-refundable. Non-refundable.
   
     ____  Combo: All three Certifications in one Money-Saving Combination. Be trained and Certified as Certified Mold Inspector, Certified Mold Remediator, and Certified Environmental Hygienist for only US$1,999.00 including first year PCI Certification membership dues a saving of US$295.

      All payments are in US$ or the equivalent value of another widely-accepted currency.

If I am accepted by the Professional Certification Institute, I, and the organization that I may represent, will always follow the Code of Ethics of P.C.I. I understand and agree that my professional designations will be terminated if I violate the Code of Ethics, or if I do not pay my annual renewal PCI membership dues [currently $49.00 per certification designation].  To accompany this training application, I will process a payment to PCI using one of the Payment Options listed at the bottom this page, or by my check or bank wire.

If you have completed ANY post-high school college, trade, or technical education programs of any kind, please provide the details including school name, school location, year of graduation or completion of course, subjects studied, and any other helpful info. Attach extra sheets of paper if needed.

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Please describe in detail all or your business/work/career experiences that you believe would be helpful to your successful career as a certified environmental professional.  [please include details such as skills learned, employer names and addresses, and dates]. Attach extra sheets of paper if needed.

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Please provide the names, nature of relationship [how you know each person], company [if relevant], complete mailing address, and current phone number of at least three persons who personally know your work abilities and/or general character. Your most ideal references would be your business/professional clients or co-workers. Please do NOT submit references who are your relatives or employees. Attach extra sheets if needed.

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I certify that the above information is totally true and complete. I authorize my references to provide complete information about myself to the Professional Certification Institute.

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                  My Signature                                                                                          Date