Specimen Collector

New Student Application

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DOT Certified Specimen Collector

Nationally recognized — certified in all 50 states

✅ Learn the step-by-step process to become a DOT Certified Specimen Collector
✅ Handle shy bladder, temperature discrepancies, and refusal situations with confidence
✅ Get a clear understanding of DOT 49 CFR Part 40 regulations
✅ Accurately complete the Federal Chain of Custody (CCF) form every time
✅ Earn a 5-year DOT Collector Certification that’s accepted nationwide
✅ Includes a live Mock Collections Exam for hands-on practice

COURSE SUPPLY LIST:
1. Computer / Laptop
2. Notebook & Pen
3. Mock Collections Exam Kit
4. Donor for the Mock Collections Exam
5. Printer for study documents & assignments

First Name *

Last Name *

Address *

Street Address

City

State

Country

Postal code

Phone *

Email *

1. Are you a U.S. Citizen? *

Yes

No

2. Do you have a valid, unexpired government-issued photo ID? *

Yes

No

Please upload a valid Id *

3. This is a self-paced, self-study e-learning course. Do you agree to take full responsibility for your learning and completion of all units independently? *

Yes, I am ready to commit to my success.

4. Do you understand that you must pass all units and the final exam with a score of 100% to qualify for your Mock Collections Exam and Certification? *

Yes, I understand and will strive for 100%.

5. Do you agree to take your Mock Collection Exam within 30 days of passing your final course exam? *

Yes, I will schedule it within 30 days.

6. Do you understand that you are required to purchase your own Mock Collection Training Kit before taking the mock exam? *

Yes, I understand I will purchase my kit.

7. Do you have a donor over the age of 18 who will be available to role-play as your donor during the mock collection exam and remain present for the entire exam? *

Yes, I have a donor available.

No, I need to arrange this before enrolling.

8. Do you understand and agree that there are no refunds for this course as it is a digital learning program with immediate access to proprietary materials? *

Yes, I agree to the No Refunds Policy.

Final Student Declaration - By checking below, you confirm: ✅ I meet all eligibility requirements listed above. ✅ I commit to completing this course with excellence and integrity. ✅ I understand and accept all mandatory passing requirements, deadlines, and policies. *

I agree to all terms and requirements listed in this application.

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Electronic Signature (Type Full Name) *

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