New Jersey Ofce of the Attorney General
Division of Consumer Affairs
State Board of Examiners of Master Plumbers
124 Halsey Street, 6th Floor, P.O. Box 45008
Newark, New Jersey 07101
(973) 504-6420
Application for Continuing Education
Instructor/Course Approval
To Be Completed Prior to July 1, 2019
Information that you provide on this application may be subject to public disclosure as required by the Open Public Records
Act (OPRA).
Date: __________________________
Information for website:
Name of Instructor: ___________________________________________________________________________
Last name First name Middle name
Address: ____________________________________________________________________________________
Street address City State ZIP code
Home telephone number: _____________________________ Cellular number: ___________________________
(include area code) (include area code)
New Jersey Licensed Master Plumber Number:______________________________________________________
(If applicable)
Email address: ________________________________________________________________________________
Instructor Number (for previously approved instructors): ______________________________________________
Attach the following:
1. Resume/Curriculum vitae
2. Course outline/syllabus
3. Non-refundable check or money order in the amount of $100.00 made payable to:
“State of New Jersey”
Mail all items to the P.O. Box listed above. New Instructors will be scheduled to appear before the Board after all
items have been received.
Previously approved instructors will be scgeduled to appear before the Board only if the Board has follow-up
questions after review of all items.
Please refer to the information concerning HVACR continuing education which was published in the New Jersey
Register on August 6, 2018 for the required topics.
