DDW-2025-002261

Checklist Instructions:
☐Step 1
☐Step 2
☐Step 3
Contact Information (person submitting CEU's)
Name Phone
Organization Email
Course Information
Title Duration (in hours)
Location (City & State or Online)Date
Continue onto the next step: Course Attendance List
Located on the second page or the second tab/sheet.
Course Description & Objectives
Details about the subjects covered and the course content. This is required for CEU credit approval.
Instructor/Presenter Bio
Details about the presenters' qualifications & experience. This is required for in-house trainings & pre-authorizations.
Utah Operator Certification Program
Continuing Education Unit (CEU)
Course Accreditation Application
Complete ALL the Steps and this application for the course to be approved by the Secretary of the Operator
Certification Commission.
Attach course documentation and the attendance list to this application for approval.
Examples: course outlines, agendas, presenter bio's, & certificates of completion.
Submit application and course related documents to the Division of Drinking Water.
Division of Drinking Water
Operator Certification Program
P.O. Box 144830 • Salt Lake City, UT 84114
Phone:[phone]
E-mail:[e-mail]
DDWOpCert.Utah.gov
Course Attendance List
Course Information Page 2 of the Course Accreditation Application
Title Duration (in hours)
Location (City & State or Online)Date
Op Cert#First Name Last Name
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Duplicate this page or insert more rows as needed.Page:
Course Description & Objectives
Instructor/Presenter Bio
Employer