Re-Designation Form

NXT Level 1 - Re-designation Questionnaire

Step 1 of 6 - Introduction

NXT Level 1 - Re-designation Questionnaire
To maintain the NXT Level 1 designation, individuals must earn 18 Continuing Education Units (CEUs) in each 3-year cycle. This requirement is waived for individuals currently enrolled in the NXT Level 2 training program. If you would like to enroll in Level 2, please let us know.
- For each course you completed in the last 3 years, provide:
  - Name of the Course
  - Entity Providing CEUs
  - Date Completed
  - Number of CEUs earned for the course
    If you have questions, contact info@nxtleveltraining.com for assistance.

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Individual Name:*
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Applicant Email Address (Email for point of contact who will be handling application process on behalf of company)*
Please use the fields below to describe the courses you have completed that earned you the equivalent of 18 CEUs in the previous 3 years. Additional courses can be detailed on the next page.
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Additional Coursework
You may list additional courses on this and the following pages to detail a minimum of 18 CEUs (or equivalent). If you are done, click "Next" and "Submit"
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Utility/Lighting Program:*
Click and begin typing to find the appropriate incentive program
Course Name:
Entity Providing CEUs
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*
- I have permission from this customer to provide their name, contact information and project information on this application
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- Okay to contact for customer reference?
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Date Completed:
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Number of CEUs or equivalent:
Number of CEUs or equivalent
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Project Location Address:
Street Address City State ZIP Code
Date Completed:
MM slash DD slash YYYY
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Finish Date:
MM slash DD slash YYYY
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What components of the project did your company perform? Check all that apply.
- Commercial lighting project sales & proposal development
- Commercial lighting system audits & assessments
- Design & Specification of lighting systems and/or lighting products
- Commercial lighting project submittals for utility/conservation programs
- Installation of lighting and/or lighting control systems
- Commissioning of lighting and/or lighting control systems; End user training

Save and Continue Later

Additional Coursework
You may list additional courses on this and the following pages to detail a minimum of 18 CEUs (or equivalent). If you are done, click "Next" and "Submit"
Hidden
Utility/Lighting Program:
Click and begin typing to find the appropriate program
Course Name:
Entity Providing CEUs:
Hidden
- I have permission from this customer to provide their name, contact information and project information on this application
Hidden
- Okay to contact for customer reference?
Hidden
Customer Contact Email Address:
Hidden
Customer Contact Phone Number:
Number of CEUs or equivalent:
Hidden
Project Location Address:
Street Address City State ZIP Code
Completed Date:
MM slash DD slash YYYY
Hidden
Finish Date:
MM slash DD slash YYYY
Hidden
What components of the project did your company perform?
Check all that apply.
- Commercial lighting project sales & proposal development
- Commercial lighting system audits & assessments
- Design & Specification of lighting systems and/or lighting products
- Commercial lighting project submittals for utility/conservation programs
- Installation of lighting and/or lighting control systems
- Commissioning of lighting and/or lighting control systems; End user training

Save and Continue Later

Additional Coursework
You may list additional courses on this and the following pages to detail a minimum of 18 CEUs (or equivalent). If you are done, click "Next" and "Submit"
Hidden
Utility/Lighting Program:
Click and begin typing to find the appropriate program
Course Name:
Entity Providing CEUs:
Hidden
- I have permission from this customer to provide their name, contact information and project information on this application
Hidden
- Okay to contact for customer reference?
Hidden
Customer contact phone number:
Number of CEUs or equivalent:
Hidden
Project Location address:
Street Address City State ZIP Code
Completed date:
MM slash DD slash YYYY
Hidden
Finish date:
MM slash DD slash YYYY
Hidden
What components of the project did your company perform?
Check all that apply.
- Commercial lighting project sales & proposal development
- Conduct lighting system audits & assessments
- Design & Specification of lighting systems and/or lighting products
- Generate commercial lighting project submittals for utility/conservation programs
- Installation of lighting and/or lighting control systems
- Commission lighting and/or lighting control systems; End user training

Save and Continue Later

Additional Coursework
You may list additional courses on this and the following pages to detail a minimum of 18 CEUs (or equivalent). If you are done, click "Next" and "Submit"
Hidden
Utility/Lighting Program:
Course Name:
Entity Providing CEUs:
Hidden
- I have permission from this customer to provide their name, contact information and project information on this application
Hidden
- Okay to contact for customer reference?
Hidden
Customer contact email address:
Hidden
Customer contact phone number:
Entity Providing CEUs:
Hidden
Project Location address:
Street Address City State ZIP Code
Completed date:
MM slash DD slash YYYY
Hidden
Finish date:
MM slash DD slash YYYY
Hidden
What components of the project did your company perform?
Check all that apply.
- Commercial lighting project sales & proposal development
- Conduct lighting system audits & assessments
- Design & Specification of lighting systems and/or lighting products
- Generate commercial lighting project submittals for utility/conservation programs
- Installation of lighting and/or lighting control systems
- Commission lighting and/or lighting control systems; End user training

Save and Continue Later

Do you have additional coursework that you would like to list? If so please describe below including the course title and number of CEUs or equivalent.
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Project 5
NXT Level designated companies will be associated to the utilities/lighting programs where project references are provided. Please provide project references for all utility/lighting programs your company would like to be associated to.
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Utility/Lighting Program:
Hidden
Customer Name:
Hidden
Customer Contact Person:
Hidden
- I have permission from this customer to provide their name, contact information and project information on this application
Hidden
- Okay to contact for customer reference?
Hidden
Customer contact email address:
Hidden
Customer contact phone number:
Additional course descriptions:
Hidden
Project Location address:
Street Address City State ZIP Code
Hidden
Start date:
MM slash DD slash YYYY
Hidden
Finish date:
MM slash DD slash YYYY
Hidden
What components of the project did your company perform?
Check all that apply.
- Commercial lighting project sales & proposal development
- Conduct lighting system audits & assessments
- Design & Specification of lighting systems and/or lighting products
- Generate commercial lighting project submittals for utility/conservation programs
- Installation of lighting and/or lighting control systems
- Commission lighting and/or lighting control systems; End user training
Email
This field is for validation purposes and should be left unchanged.

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Re-Designation Form

NXT Level 1 - Re-designation Questionnaire

Step 1 of 6 - Introduction

Additional Coursework

Additional Coursework

Additional Coursework

Additional Coursework

Project 5