ONLINE REGISTRATION FORM
NEW STUDENT / RETURNING STUDENT WITH REGISTRATION CHANGES (FDOT EMPLOYEE)

This form is to be completed by FDOT Employees Only who have not been previously registered for a CTQP course or who’s personal information has changed since the last class or exam.

APPLICANT INFORMATION
(all fields required except as noted below)

 Check One New Applicant   Change of Information
First Name  
Middle Initial  
Last Name  
Title
Home Address
City
State
Zip
Home Phone  
Work Phone  
Work Fax  
FL Driver's License#  
E-mail


FLORIDA DEPT of TRANSPORTATION EMPLOYMENT INFORMATION

FDOT District
FDOT Work Address
City
State
Zip
Supervisor Name
Supervisor Phone
Supervisor Fax
Supervisor Email


FDOT TRAINING CONTACT INFORMATION

This area to be completed only by those responsible for scheduling trainees for CTQP courses. If you have not been designated as a Training Contact for your employer, please do not complete this area.
 
Training / Unit Coordinator
Cost Center
District
Suncom Phone Number Ext     
Email (@dot.state.fl.us)


QUALIFICATION

I verify that I have met all training course prerequisites...

Yes 

No  
I am seeking CTQP Qualification.
I verify that I have met all qualification work experience requirements... Yes No N/A
Enter comments below...


COURSE SELECTION & FEES


Step 1 - choose the classes you would like to attend

Step 2 - choose your preferred date or location

Step 3 - check the box with applicable course fee

CLASS SESSION # DATES LOCATION COURSE
& EXAMS
COURSE EXAM PROF

COURSE NOTE 1 - Exams and Proficiencies Only - Click Here to view reporting times for these sessions

FDOT Concrete Lab 1508 027 00

1/7/09-call to schedule

Williams Largo Ofc, 10600 Endeavour Way N/A N/A $200 N/A
F. Estimates L-1 Exam 9am-3pm Call Lynn 727-541-3444 1508 031 00

1/7/09

Williams Largo, 10600 Endeavour Way N/A N/A $185 N/A
  F. Estimates L-1 Exam 9am-3pm Call Lynn 727-541-3444 1508 031 00

Call to schedule exam date

Williams Sanford, 30 Keyes Court N/A N/A $185 N/A
F. Estimates L-2 9am-3pm Call Lynn 727-541-3444 1508 031 00

1/7/09

Williams Largo, 10600 Endeavour Way N/A N/A $185 N/A
  F. Estimates L-2 9am-3pm Call Lynn 727-541-3444 1508 031 00

Call to schedule date

Williams Sanford, 30 Keyes Court N/A N/A $185 N/A
ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams given in afternoon 1509 022 00

1/6/2009

Snapper Creek INST: ANDY WHITE $350 $75 $150 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams given in afternoon 1509 022 00

1/20/2009

Hampton Inn, 2909 Thomas Dr., Panama City Beach, INST: ANDY WHITE $350 $75 $150 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams given in afternoon 1508 000 00

2/17/2009

Jacksonville Location TBD - INST: Andy White $350 $75 $150 $200
  ASPHALT PAVING LEVEL 1-One day class-Written & Prof Exams given in afternoon 1509 022 00

3/24/2009

Williams Sanford Ofc, INST: Andy White $350 $75 $150 $200
Asphalt Pave L-1 PROFICIENCY 9am-3pm Call 727-541-3444 Josette or Lynn 1507-022-00

Call to schedule date & time

Williams Sanford Ofc, 30 Keyes Ct, N/A N/A N/A $200
ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1509 023 00

1/7-9/2009

Snapper Creek INST: KIKO VILLARREAL $600 $350 $275 N/A
  ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1508 000 00

2/18-20/2009

Jacksonville-Location TBD INST: Andy White $600 $350 $275 N/A
  ASPHALT PAVING LEVEL 2 - Three-day class - Written Exam on day 3 1509 023 00

3/25-27/2009

Williams Sanford Ofc, INST: Andy White $600 $350 $275 N/A
ASPHALT PLANT LEVEL 1 1509 020 00

1/6-1/8/2009

Williams Sanford Ofc, 30 Keyes Court, $875 $400 $200 $275
  ASPHALT PLANT LEVEL 1 1509 020 00

2/10-12/2009

Williams Sanford Ofc, 30 Keyes Ct, INST: A. White $875 $400 $200 $275
ASPHALT PLANT LEVEL 2 - Three-day class - Written Exam on day 3 1509 021 00

1/21-23/2009

Hampton Inn, 2909 Thomas Dr, Panama City Beach INST: Andy White $600 $350 $275 N/A
  ASPHALT PLANT LEVEL 2 - Three-day class - Written Exam on day 3 1509 021 00

2/24-26/2009

Banquet Masters, 8100 Park Blvd, INST: A. White $600 $350 $275 N/A
  ASPHALT PLANT LEVEL 2 - Three-day class - Written Exam on day 3 1509 000 00

3/17-19/2009

Jacksonville $600 $350 $275 N/A
Conc Batch Plant Op Exam 9am-3pm Call 727-541-3444 Josette or Lynn 1508 000 00

1/7/09 call to schedule

Williams Largo Ofc N/A N/A N/A N/A
CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

2/17-2/18/2009

Hampton Inn, 2909 Thomas Dr, Panama City Beach INST: KIKO VILLARREAL $400 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

2/3-4/2009

Courtyard Marriott S. Jacksonville INST: FRED JOHNS $400 $225 $185 N/A
  CONCRETE FIELD INSP SPEC - 2 day class - Written Exam on day 2 1509 026 00

3/3-3/4/2009

Snapper Creek $400 $225 $185 N/A
DRILLED SHAFT INSPECTORS QUAL-3 Day Class-Written Exam on day 3 1509 028 00

1/13-15/2009

Banquet Masters, 8100 Park Blvd, Pinellas Park $675 $425 $275 N/A
  DRILLED SHAFT INSPECTORS QUAL-3 Day Class-Written Exam on day 3 1509 028 00

2/17-2/19/2009

Jacksonville INST: K Bennett $675 $425 $275 N/A
  DRILLED SHAFT INSPECTORS QUAL-3 Day Class-Written Exam on day 3 1509 028 00

3/3-4/2009

Snapper Creek $675 $425 $275 N/A
  DRILLED SHAFT INSPECTORS QUAL-3 Day Class-Written Exam on day 3 1508 028 00

4/21-23/2009

Williams Sanford Ofc, 30 Keyes Ct INST: Keith Bennett $675 $425 $275 N/A
EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1508 024 00

1/27-28/2009

Banquet Masters, 8100 Park Blvd INST: K VILLARREAL $450 $125 $185 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

2/10-11/2009

Hampton Inn, 2909 Thomas Dr Panama City Beach INST: K. VILLARREAL $450 $125 $185 $175
  EARTHWORK LEVEL 1 - Two day class - Written & Prof Exams on day 2 1509 024 00

3/17-18/2009

Snapper Creek INST: Kiko Villarreal $450 $125 $185 $175
EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

1/29-30/2009

Banquet Masters, 8100 Park Blvd, INST: K VILLARREAL $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

2/12-13/2009

Hampton Inn, 2909 Thomas Dr, Panama City Beach. INST: K VILLARREAL $400 $225 $185 N/A
  EARTHWORK LEVEL 2 - Two day class - Written Exam on day 2 1509 025 00

3/19-20/2009

Snapper Creek INST: KIKO VILLARREAL $400 $225 $185 N/A
PILE DRIVING INSPECTION-3 day class-Written&Prof Exams on day 3 1509 029 00

1/27-29/2009

Williams Sanford Ofc, 30 Keyes Ct INST: K BENNETT $1000 $475 $275 $275
  PILE DRIVING INSPECTION-3 day class-Written&Prof Exams on day 3 1509 029 00

2/11-13/2009

HAMPTON INN AIRPORT,Jacksonville INST: K BENNETT $1000 $475 $275 $275
  PILE DRIVING INSPECTION-3 day class-Written&Prof Exams on day 3 1509 029 00

3/10-12/2009

Snapper Creek INST: KEITH BENNETT $1000 $475 $275 $275
  PILE DRIVING INSPECTION-3 day class-Written&Prof Exams on day 3 1508 028 00