HOW TO FILL OUT NCCER’S FORM 200
After completion of this Form, send to:
ABC Central Texas
3006 Longhorn Blvd., #104
Austin, TX 78758
Office: 512-719-5263
Fax: 512-719-3278
At the end of the training period, the instructor will fill out a Form 200. The purpose of this form to provide information on completion of modules for each student taught in order to receive certification for that class.
The following information should help you with any questions you may have regarding how to fill out the Form 200.
- ATS NAME: ABC CENTRAL TEXAS
- ATU/TU/ATEF: Write the name of your high school here. This will indicate to NCCER where to send the certificates
- Instructor/Performance Evaluator & Social Security Number: Print your name and your social security number
- Performance Evaluator: Leave blank
- Completion Date: The last date the course was taught
- Do not send credentials at this time: Do NOT check this box!
- Trainee Name: John Doe
- Release Form: Place a check (you will be remitting to me the Registration and Release forms that you had your students fill out along with this Form 200)
- Trainee Social Security Number: Should the student not have a social security number, the instructor must forward to me the student’s name and date of birth and I will obtain a system designated number from NCCER. Upon receipt of this number, I will send that number to the instructor. You may send me this information via email to Janie@abccentraltexas.org or you may fax the request to the number listed above.
- Trainee Employer: Can be left blank for secondary schools
- Employer Zip Code: Can be left blank for secondary schools
- Mod. & Suffix: The entire seven (7) digit number, including the number after the dash needs to go here. Example: 00101-08
- Written Test: The date the test was administered, not the grade
- Performance Test: Just enter “P” for Pass
- Certified Instructor Signature, Date, Printed Certified Instructor Name, Social Security Number - This is for the instructor who taught the class to fill out his/her information
- ATU/TU/ATEF Representative: This can be left blank
- Sponsor Representative: This is for Janie Good J