Minnesota Department of Labor and Industry Residential Building Contractors 443 Lafayette Road N. St.

Paul, MN 55155 (651) 284-5065

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Continuing Education Notice of Subsequent Offering

Instructions PRINT IN INK or TYPE your responses 1. The coordinator must complete and sign this application; the completed application must be submitted to the Department of Labor and Industry at least 30 days before the subsequent offering date indicated in this notice. 2. If the course was originally approved more than one year prior to this subsequent offering date, the coordinator must (a) attach copy of the original course outline and (b) complete the “Detailed course outline” section of this form. 3. A subsequent offering of an identical continuing education course does not require a new application or fee if the coordinator submits a “Notice of subsequent offering” to the Department of Labor and Industry at least 30 days in advance of the subsequent offering date stated on this form. 4. Approval will not be granted for a subsequent offering if the course is determined not to be in compliance with the laws relating to course approval. If denied, a denial letter will be mailed within 30 days of receipt of the subsequent offering notice. If approved, the course and the subsequent offering date will be listed on the Department of Labor and Industry Web site (no approval letter will be sent). COURSE INFORMATION DATE OF SUBSEQUENT OFFERING OF APPROVED COURSE (This application must be submitted at least 30 days before the subsequent offering date stated here.) COURSE/SEMINAR LOCATION (Name of building or facility where course is to be offered) ADDRESS OF FACILITY COURSE TITLE CITY TELEPHONE NUMBER OF FACILITY STATE ZIP CODE

COURSE APPROVAL NUMBER

Number of hours originally approved: Original course approval date:

hours for

contractor

remodeler

roofer

If the original approval date was more than one year prior to the subsequent offering date stated in this form, coordinator must complete attached “Detailed course outline” section. • Continuing education consists of courses that impart substantive knowledge that is appropriate and related to the contractor field. The burden of demonstrating that courses impart substantive residential contractor knowledge is upon the person seeking approval or credit. • Continuing education credit will not be approved for the following: ⌦ sales promotion, general business meetings or training ⌦ training in mechanical office business skills, including typing, primarily for marketing specific products of specific calculators, or other office machines or equipment. (Portions of companies. computer courses that impart substantive contractor knowledge will be allowed.) ⌦ training in motivation, effective sales technique, ⌦ courses designed solely to prepare students for passing a license psychology, time management or communication. examination. ⌦ time spent on meals or other unrelated activities. Is this a contractor course that offers training about lead abatement rules? If yes, indicate number: lead abatement hours Yes No energy code hours

SPONSOR/COORDINATOR/INSTRUCTOR INFORMATION SPONSOR NAME SPONSOR ADDRESS COORDINATOR NAME INSTRUCTOR NAME CITY STATE

SPONSOR IDENTIFICATION NUMBER ZIP CODE SPONSOR FAX NUMBER

COORINDATOR BUSINESS PHONE

COORDINATOR BUSINESS E-MAIL

a four-year degree in any area, plus two years practical experience in the subject area being taught five years practical experience in the subject area being taught a college or graduate degree in the subject area being taught Coordinator must submit the instructor name and qualification in writing to the Department of Labor and Industry prior to the subsequent offering date stated in this notice.
Check one qualification at right (mandatory) Office Use Only Denied by Approved by Contractor Roofer Remodeler COURSE NUMBER gen hrs gen hrs gen hrs DATE PROCESSED energy hrs lead hrs energy hrs lead hrs

RBC 03 (1/06)

(over)

Detailed content outline
Content outline must be completed if course was originally approved more than one year prior to the subsequent offering date stated in this notice.

Segments must be listed in increments of 15 minutes or fewer. Break times must be indicated. (Attach additional sheets if necessary). Example: Methods of valuation - Introduction Cost approach Cost approach Income approach

Scheduled time 8:30 to 8:45 a.m. 8:45 to 9 a.m. 9 to 9:15 a.m. 9:15 to 9:30 a.m.

Number of minutes 15 15 15 15

Total course hours: Certification
• • •

I certify I am the approved coordinator for the sponsor and I am responsible for compliance with Minnesota education laws and regulations. I certify the continuing education course listed in this “Notice of subsequent offering” is identical to the continuing education course that was originally approved by the Department of Labor and Industry. I certify all of the information submitted in this application is true and complete, and that this document has not been changed in any manner from the form adopted by the Department of Labor and Industry. DATE

SIGNATURE OF COORINDATOR (mandatory)

This material can be made available in different forms, such as large print, Braille or on a tape. To request, call 1-800-342-5354 (DIAL-DLI) Voice or TDD (651) 297-4198.