MINNESOTA DEPARTMENT OF HEALTH
FOOD, POOLS, AND LODGING SERVICES SECTION
625 ROBERT STREET NORTH, P.O. BOX 64495
ST. PAUL, MINNESOTA 55164-0495
651-201-4500
http://www.health.state.mn.us/divs/eh/san/index.html
APPLICATION TO RETAKE THE REGISTERED ENVIRONMENTAL HEALTH SPECIALIST/
REGISTERED SANITARIAN (R.E.H.S./R.S.) EXAM
STEP 1: Applicant Information
Name: ________________________________________________________________________________________________________________
Last
First
Middle Initial
Address:
County____________________
Street/PO Box
Telephone (Contact):
City
State
________________________________________________
Zip
Fax: _____________________________________
Email: ________________________________________________________
STEP 2: Payment and Signature
Please return the form and the fee by February 15th for the exam held in April and August 15th for the exam held
in October.
This application must be accompanied by:
1. A $125 fee made payable to NEHA for the examination
2. Submit application and fee to the address listed below:
MINNESOTA DEPARTMENT OF HEALTH
FOOD, POOLS, AND LODGING SERVICES SECTION
ATTENTION: SANITARIAN REGISTRATION PROGRAM
625 ROBERT STREET NORTH, P.O. BOX 64495
ST. PAUL, MINNESOTA 55164-0495
I certify that the information provided on this application is accurate and complete:
Signature ______________________________________________
All information on this document is public
Date: _______/________/___________
Notice: The issuance of a dishonored check to this department will require a service charge of $30 per check as in Minnesota Statutes,
604.113, subd. 2 (a). Additional civil penalties may be imposed for nonpayment.
If you require this document in another format, call 651-201-4500.
April 2014-version 1.0