First, please use your mouse curser to select and then copy just the form
wording below. Second, paste the copied wording onto a new word document
in your computer. Third, print that new word document page. Fourth,
complete (in legible black
ink printing) and sign this Professional Industrial Hygienist Training
Application, along with the
Code of Ethics.
Fifth, use a scanner to scan the
completed/signed Training Application and the Code of Ethics and
then email both documents to as email attachments to
or mail your completed and signed documents to the Environmental
Hygienists Association, P.O. Box 32002, Mesa, AZ 85275, USA.
Training Application for Professional Industrial Hygienist
__________________________ Postal Code: ____________
Daytime phone: (________ )_____________________
Evening phone: (________ )____________________
Professional Industrial Hygienists
I herein apply to be trained and designated as a Professional
Industrial Hygienist (P.I.H.). If I am
accepted by the Professional Industrial Hygienists, I will always follow
and abide by the P.I.H.
Code of Ethics. I understand and agree that my P.I.H.
designation will be terminated if I violate the
Code of Ethics, or if I do not pay my annual renewal P.I.H. membership
renewal dues (currently $99.00). To accompany this training application,
I will make payment of the $999 tuition (or the $300 tuition down payment
for installment terms) to Professional Industrial Hygienists
by using the PayPal payment link on the
home page, or by bank wire (contact us for bank wire instructions) or
by phoning my credit card details to Phillip Fry 1-480-217-7173 or
If you have completed ANY post-high school
college, trade, or vocational education programs of any kind, please
provide the details including school name, school location, year of
graduation or completion of course, subjects studied, and any other
helpful info. Attach extra sheets of paper if needed.
describe in detail all or your business/work/career experiences that you
believe would be helpful to your successful career as a Professional
Industrial Hygienist. Please include details such as skills learned,
employer names and addresses, and dates. Attach extra sheets of paper if
provide the names, nature of relationship (how you know each person),
company (if relevant), complete mailing address, and current phone number
of three persons who personally know your work abilities and/or general
character. Your most ideal references would be your present or past
employers, co-workers, and/or business/professional clients. Please do
NOT submit references who are your relatives or your employees. Attach
extra sheets if needed.
certify that the above information is totally true and complete. I
authorize my references to provide complete information about myself to
the Professional Industrial Hygienists.