MTM/CTAA Pass Certification Registration Form

MTM/CTAA PASS Certification Registration Form
Participant's Name

First NameMiddle NameLast Name
Provider Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Individual emails are required for every driver.

The email that is entered will be where the CTAA On-Demand training will be sent to as well as the certificate of completion. The On-Demand training will have to be completed and certificate issued before attending the hands-on training. The On-Demand training runs around 4-6 hours.

If you have a current, unexpired CTAA issued certification (including securement) please upload to your credentials. No further action is needed on this form.

For any provider that performs wheelchair trips, all drivers will be required to take PASS training. If the Provider does NOT take any wheelchair trips, they will be provided a waiver.

This is a one-day class held from 8:00 AM to 2:30 PM EST, with a scheduled break and a lunch period.
DMAS Training Grid
Participant's E-mail

Confirmation Emailexample@example.com
Participant's Phone Number
Format: (000) 000-0000.
Provider Phone Number
Format: (000) 000-0000.
Company
What level of service do you provide? Reminder for any provider that performs wheelchair trips, all drivers will be required to take PASS training. PASS training is not needed for ambulatory only drivers.
Type of vehicle bringing:
Choose one date from the list below. Dates are grouped by location.
Fairfax
Roanoke
Richmond (1)
Richmond (2)
Newport News
Winchester
Current Certifications
I confirm that the email entered is correct and that the training date and location I selected are correct and agree to attend the appropriate session.
Should be Empty:

MTM/CTAA PASS Certification Registration Form

Choose one date from the list below. Dates are grouped by location.