Course Pre-Approval Request Form

Submitted by JCAttamack on Tue, 04/08/2025 - 11:49

Please complete this form to request course pre-approval. All courses must be pre-approved by the WCCC Review Committee at least 30 days prior to the course date. Check Review Committee meeting dates to ensure your request will be reviewed in time.

You must also submit via email or mail: A detailed timed agenda for the course (including topics, course times and time allotted for meals and breaks), qualifications for each instructor and a sample completion certificate.

Email: bryan.colvard@dhhs.nc.gov and casey.champion@dhhs.nc.gov
Mail: NC Well Contractors Certification Commission, 1653 Mail Service Center, 5605 Six Forks Road, Raleigh, NC 27699-1653

Current Applicant Information
Course Information
Provide Contact Information to Register
Signature Page
Complete

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First name

Last name

Address

Address 2

City/Town

State

ZIP Code

Email address

Phone

Well contractor certification number

NCWC

Applicant is:

Course attendee

Course instructor/provider

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