MNCWTA Training Portal Profile Request

Notice

If you are a new employee, your direct supervisor should invite you to set up your new MNCWTA Training Portal Profile. Otherwise, please complete the form below for a new MNCWTA Training Portal Profile and it will be reviewed and approved by the MNCWTA Staff Member.

Fields marked with an asterisk are required.

Your Information

First name*

Middle initial

Last name*

Preferred name

Birth year*

We are asking for birth year as an additional way to authenticate each user.

Work Email*

You must use your work email for us to verify who you are

Phone*

Please indicate your current title/role:*

Other job title

Start date

Please enter the approximate start date for your current position.

Your Employer

Agency type*

Agency*

Please choose your primary agency

Please enter your agency's name

Direct Supervisor

Supervisor first name

Supervisor last name

Supervisor's Email

Additional Information

Additional Comments

Please include any additional comments regarding this request.

Fax*

Captcha*

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