Irrigation Employer Water Smart Irrigation Professional Training and Certification Application

Irrigation Employer Water Smart Irrigation Professional Training and Certification Application Form

Company Name:

Name of Owner:

Company Website:

Address:

Phone Number:

Email:

1)Complete the table below for all applicants to the Water Smart Irrigation Professional program. Note: each company must have one owner/company principal and one technician available to take the program.

Participant Name / Email / Valid CLIA Certification?* / Membership with Landscape Ontario?
(owner/principal) / Yes
No
In progress / Yes
No
Will join
(technician) / Yes
No
In progress / Yes
No
Will join

*If no (or in progress), applicant is required to pass the CLIA exam or in-field CLIA requirements and submit proof of completion to LO prior to August21, 2015.

2)Explain why your company wants to participate in the Water Smart Irrigation Professional training and certification program, emphasizing the importance of the program and why you feel you and your staff are good candidates.

Contractors are encouraged to provide a convincing rational as to why they should be chosen for the program.(Minimum 250 word count, maximum 500 words)

3)Each employer must service a minimum of 5 privately held Industrial Commercial or Institutional (ICI) facilities in the 2015 season within the Region of Peel or York Region. Please indicate how many ICI clients you have in each Region that would be good candidates for an ICI irrigation system performance audit.

Number of ICI clients
Region of Peel
York Region

4)Does your company have access to computers (portable laptops and tablets) with Microsoft Office Excel software for the purposes of this training and certification program?

Yes No

5)In order to measure the success of the WSIP program, Landscape Ontario will be surveying and/or holding focus group sessions with participating ICI customers and irrigation contractors.

Your feedback is important to us. Are you willing to work with Landscape Ontario and the municipalities to provide feedback following the 2015 season?

Yes No

6)If approved, my firm will participate in the following Training program dates:(Please check all that apply)

September 9/10, 2015

September 14/15, 2015

7)If approved, my firm will complete the Certification Validation on a site located within the Region of Peel and the final written exam on which of the following dates: (It will require 1 full day per firm). (Please check all that apply)

September 17 September 18

September 21 September 22

I certify that the statements and information in this application form aretrue and correct to the best of my knowledge and belief. I authorize Landscape Ontario, the Region of Peel and York Region to investigate all statements or other informationcontained in this application form.

______

Signature of OwnerDate

______

Signature of TechnicianDate

The application review committee, (which includes representatives from the program Partners), reserves the right to accept or reject any application or any part thereof and that at any time and for any reason, the Partners may refuse any or all further contractors for the Course , may extend the deadline for applications for the Course, or any other deadline, or may terminate the Course.

WSIP Participants understand that following Certification, participants may be requested to enter into an agreement with the Regions for participation in the Region’s respective water efficiency programs.

Please submit this application (one per company) on or before July31,2015 at noon.

Submit to:

Attention: Water Smart Irrigation Professional Training

Landscape Ontario

7856 Fifth Line, S. R.R. #4

Milton, Ontario L9T 2X8

Or by email to

For more information, please contact Sally Harvey at 647-723-5450.