NorthEast Transportation Training and Certification Program (NETTCP) Course Registration Form

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1 (NETTCP) Course Registration Form Interim Certification (Cost $300 members / $425 non-members) HMA Plant Technician* HMA Paving Inspector* Soils & Aggregate Inspector* Soils & Aggregate Lab Technician* Concrete Technician* Concrete Inspector* Drilled Shaft Inspector Driven Pile Inspector Subsurface Inspector PG Asphalt Binder Laboratory Technician *Requires a completed (select from following pages) Name: Cell Phone: P.O. Box: Home Street: City: State: Zip: Phone: P.O. Box: Street: City: State: Zip: Candidate s Signature*: Last 4 Digits of Cell Phone: *Signatures indicate that the candidate is aware of all NETTCP Policies including the Photograph Policy, the Refund Policy and the Cancellation Policy. Information mailed to: Home Business Note: Manuals cannot be shipped to a PO Box. Instructions 1. Fill out registration form completely (both addresses, zip codes, etc.). 2. If required, attach (see appropriate certification section). 3. If applying for a HMA Paving Inspector or Soils and Aggregate Inspector Interim Certification a copy of your nuclear gauge certification must be submitted. 4. If applying for a Concrete Technician Interim Certification a copy of your current ACI Grade 1 Field Certification must be submitted. 5. Enclose a check made out to NETTCP for the full amount and forward all forms and check to the address shown below. 6. NETTCP accepts Visa, Mastercard and American Express credit cards for online orders, visit

2 Soils and Aggregate Inspector Certification Note: A qualified holder of a Soils and Aggregate Inspector Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date 1 T2 Standard Practice for Sampling Aggregates 2 T248 Reducing Sample of Aggregate to Testing Size 3a T310 In Place Density and Moisture of Soil and Soil Aggregate by Nuclear Methods 3b T99 or T180 Or 3b Moisture Density Relation of Soils

3 PG Asphalt Binder Laboratory Technician Certification Note: A qualified holder of a PG Asphalt Binder Laboratory Technician Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date 1 T240 Effect of Heat and Air on a Moving Film of Asphalt (Rolling Thin Film Oven Test) 2 R28 Accelerated Aging of Asphalt Binder Using a Pressurized Aging Vessel (PAV) 3 T316 Viscosity Determination of Asphalt Binder using Rotational Viscometer 4 T315 Determining the Rheological Properties of Asphalt Binder Using a Dynamic Shear Rheometer (DSR) 5 T313 Determining Flexural Creep Stiffness of Asphalt Binder Using the Bending Beam Rheometer (BBR) 6 T228 Specific Gravity of Semi Solid Bituminous Materials Participants attending the course have the option of taking the Direct Tension (DT) performance test and written examination for DT certification. All participants will be given classroom instruction on the DT. Those participants who are seeking certification for the DT are required to complete section #7 below. 7 T314 Determining the Fracture Properties of Asphalt Binder in Direct Tension (DT) Equipment Experience Direct Tension Apparatus Manufacturer: Model Number:

4 Hot Mix Asphalt Plant Technician Certification Name: Note: A qualified holder of a Hot Mix Asphalt Plant Technician Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date Approved By Cert Date 1 T2 Sampling of Aggregates 2 T248 Reducing Field Samples of Aggregate 3 Hot & Cold Bin Sampling 4 T27 Sieve Analysis of Aggregate 5 T168 Sampling Paving Mixtures 6 T164 or T308 Quantitative Centrifuge Extraction or Ignition Oven 7 T30 Sieve Analysis of Extracted Aggregate (Wet or Dry) 8 T312 Fabricating SuperPave Specimens 9 HMA and Binder Temperature

5 Hot Mix Asphalt Paving Inspector Certification Note: A qualified holder of a Hot Mix Asphalt Paving Inspector Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date 1 Surface Preparation for HMA Pavements 2 Placement and Compaction of HMA Pavements 3 Field Temperature Measurements of Hot Mix Asphalt 4 ASTM D2950 Density of Bituminous Concrete in Place by Nuclear Methods

6 Concrete Technician Certification Note: A qualified holder of a Concrete Technician Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date 1 T2 Sampling Aggregates 2 T248 Reducing Field Sample Sizes of Aggregate to Testing Size 3 T27 Sieve Analysis of Fine and Coarse Aggregates 4 T255 Moisture in Aggregate by Drying

7 Concrete Inspector Certification Note: A qualified holder of a Concrete Inspector Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date 1 Reading and Understanding Plans, Shop Drawings and Specifications 2 Basic Knowledge of Concrete (components, batching, mixing, admixtures, slump, unit weight, strength and air content) 3 Pre placement Operations (forms, sub grade, reinforcement and equipment) 4 Placement Operations (delivery, consolidation and finishing) 5 Post placement Operations (curing and repair)

8 Soils and Aggregate Laboratory Technician Certification Note: A qualified holder of a Soils and Aggregate Laboratory Technician Certification who is signing this form must be sure that the candidate meets the required prerequisites. Qualified holders are referred to the NETTCP Sign Off Policy. Item AASHTO Description Approved By Cert Date 1 T11 Material Finer than 0.75mm (#200) Sieve in Mineral Aggregates by Washing 2 T27 Sieve Analysis for Fine and Coarse Aggregates 3 T84 Specific Gravity and Absorption of Fine Aggregates 4 T85 Specific Gravity and Absorption of Coarse Aggregates 5 T99, T180 Moisture Density Relation of Soils (either one) 6 T248 Reducing Field Samples of Aggregates to Testing Size 7 T255 Total Evaporable Moisture Content by Drying

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