Change of Information Form

Certified BATs must submit this form to notify Washington Certification Services of changes to their contact information. The Waterworks Operator Certification Program will not consider appeals from a BAT that is assessed a renewal late fee, or that does not renew a certificate or meet the professional growth requirement due to failure to report a change or provide a valid email address. Only a home address will be accepted as the mailing address of record. A business or employer address may not be used.

Required Information

* Required Verification Information:

Information Changes

Please fill out all that apply.

Name Change

I authorize Washington Certification Services to make these changes to my current information. *Authorization Required