Application - AALSSC

Name (as to appear on certificate)*

*First (required) Middle *Last (required) Suffix

Email*

Which Test Are You Taking?*

Name of Proctor*

Expected Date of Testing (estimate)*

Testing Location*

Name of current Green Belt or equivalent certification

Organization who provided the certification

As provided for under the ADA (Americans with Disabilities Act), do you require special needs accommodations in order to complete the certification process?*

Code of Conduct*

I have read and agree to follow AALSSC’s code of conduct (click to view)

Please describe your circumstance*