2. ServSafe Course and Proctored Exam Registration
4. Today's Date:*
   Today's Date:
6. First Name*
7. Last Name*
9. Phone Number*
10. Email*
12. Prefered contact method:*
    -- Select One --PhoneEmail
13. Would you prefer us to contact you through a text?
    -- Select One --YesNo
15. I would like to register for:*
    -- Select One --Class instruction and Proctored ExamProctored Exam

    Class instruction is not required to register for a Proctored exam.

19. **Only Submit the dates on the Environmental Health Calender **

    The Environmental Health Calendar can be found at this link: https://www.cravencountync.gov/calendar.aspx?CID=27

21. Calendar dates can be found here.
23. Class Instruction Date:
    -- Select One --11/1/20222/7/20235/2/20238/7/202311/6/2023
24. Proctored Exam Date:*
    -- Select One --11/1/2022 (I&P)11/15/2022 (P)02/7/2023 (I&P)02/21/2023 (P)05/2/2023 (I&P)05/16/2023 (P)8/7/2023 (I&P)8/21/2023 (P)11/6/2023 (I&P)11/20/2023 (P)

    P = Proctoring only offered

    I&P = Instruction and Proctoring offered

28. Payment Method*
    -- Select One --By PhoneCash payment at CCHDCheck payment at CCHD

    Phone payments can be made with debit or credit cards.

    Payment at the Craven County Health Department (CCHD) can be done with cash, card, or check.

30. A $75 fee will be required SEVEN DAYS proir to the date of Instruction and/or Proctoring.

    Payments can be made by phone at (252)-636-4936 or by cash and check at the Craven County Health Department.

32. After submitting your Registration form, a staff member will contact you through your prefered method to confirm your registration.
Leave This Blank:


36. 1. Receive an email copy of this form.
37. Email address

    This field is not part of the form submission.

38. Submit

* indicates a required field