SHA/AFDO train-the-trainer course application form – Association of Food and Drug Officials

APPLICANT INFORMATION

Name(Required)

First Last

Title(Required)

Organization(Required)

Address(Required)

Street Address City State / Province / Region ZIP / Postal Code Country

Telephone(Required)

Cell(Required)

Email(Required)

OCCUPATION AND EXPERIENCE

Position Description with relevance to HACCP and Seafood Processing:(Required)

(Expand or add information if necessary)

HACCP Experience (Implementation and Training):(Required)

(Expand or add information if necessary)

The only acceptable certificates for admittance into the TTT program are issued from the Seafood HACCP Alliance (SHA)/Association of Food and Drug Officials (AFDO) or the National Oceanic and Atmospheric Administration (NOAA). Your certificate will be verified for acceptance

Have you completed the SHA/AFDO Basic HACCP or Segment Two Course since 2011?(Required)

Yes

If no, have you completed the online Cornell Segment 1 course since 2011?

Yes

Have you completed the NOAA Seafood HACCP Course since 2011?(Required)

Yes

Please attach a copy of your NOAA Seafood HACCP Course Certificate

The above training must have been completed since the most recent major revision (currently 2011). Participants who have completed training prior to 2011 must again complete the Cornell Segment 1 plus Segment Two HACCP course; a 16 contact hour Basic HACCP course; or a HACCP course provided by the US Department of Commerce/NOAA-Seafood Inspection Program since 2011.

Max. file size: 64 MB.

Have you completed the SHA/AFDO SCP Course?(Required)

Yes

Do you plan to attend the SCP portion of the training? You will need an SCP certificate of completion in order to attend this portion of the training and receive your TTT SCP certificate(Required)

Yes

At least two (2) References Required related to HACCP and Seafood Processing Experience:(Required)

Name

Phone

Letters of Recommendation are encouraged to support experience with seafood, food safety training and HACCP.

Drop files here or

Max. file size: 64 MB, Max. files: 5.

Attach Condensed Vitae (maximum 2 pages) to include professional affiliations related to seafood safety, any related publications, training programs or seafood HACCP implementation(Required)

Max. file size: 64 MB.

RESPONSIBILITY AS SEAFOOD HACCP ALLIANCE TRAINER

By signing this document, I acknowledge that HACCP and related Sanitation Control Procedures courses, in order to be denoted as Seafood HACCP Alliance courses with Association of Food and Drug Officials (AFDO) certification, must comply with the established training protocols. These protocols can be found on the AFDO web site, https://afdo.org and include prior course approvals, use of core training manuals, standard training formats, and associated registration fees. Any misrepresentation of the Protocol, the Alliance or AFDO can result in revocation of the qualified trainer status.

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SHA/AFDO Train-the-Trainer (TTT) Course Application

APPLICANT INFORMATION

OCCUPATION AND EXPERIENCE

The only acceptable certificates for admittance into the TTT program are issued from the Seafood HACCP Alliance (SHA)/Association of Food and Drug Officials (AFDO) or the National Oceanic and Atmospheric Administration (NOAA). Your certificate will be verified for acceptance

RESPONSIBILITY AS SEAFOOD HACCP ALLIANCE TRAINER

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