Application for Continuing Education - Backflow Certification and Re-Certification

Tell us about yourself

Are you a current Ranken student?

YesNo

Are you attending this course on a company sponsorship?

YesNo

First Name

Last Name

Social Security Number

Age

Birth Date

Example: 05/21/1991

Gender

Ethnicity

Use Ctrl + click to select multiple responses.

Contact Information

Home/Main Phone

May the Ranken Admissions team text you at this number?

YesNoBy answering “Yes”, you agree to receive text messages from Ranken Technical College regarding your enrollment or other College related information. You can opt-out anytime. Message & data rates may apply. View Mobile Terms and Privacy Policy.

Work Phone

Street Address

City

State

Zip Code

Company Address

Company Name

Company Street Address

Company City

Company State

Company Zip Code

Course Information

Which of the following are you applying for?

CertificationRe-CertificationRETEST - CertificationRETEST - Re-Certification

What is your ASSE Certification Number?

What is your Missouri DNR Number?

Which Certification Session do you want to take?

All sessions take place from 8am to 4:30pm

Which Re-Certification Session do you want to take?

All sessions take place from 8am to 4:30pm

Certification and Re-Certification Details

All sessions take place from 8am to 4:30pm. Attendees will meet in the Ranken Cafeteria at 7:45am each day of classes.
For more details, please visit ranken.edu/backflow.

Materials and books: Distributed during the first class session.

Payment: Please contact the Business Office in-person or via phone at (314) 286-4869 to arrange payment. Personal checks will not be accepted unless the attendee is a current Ranken student. Cost is non-refundable.

Backflow Certification: $1025
Backflow Re-Certification: $375
Re-Certification for ABPA to ASSE Conversion: $450.

Retest Details

After completing this application, contact Dave Munie at demunie@ranken.edu or (314) 286-3362 to schedule your retest date.

Payment: Please contact the Business Office in-person or via phone at (314) 286-4869 to arrange payment. Personal checks will not be accepted unless the attendee is a current Ranken student. Cost is non-refundable.

Backflow Retest: $160

By clicking "Submit" below, I am verifying that I am expressing my intent to participate in the Backflow Certification or Re-Certification Program at Ranken Technical College. I am confirming that the above information is complete and accurate to the best of my knowledge.