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
REGISTERED ENVIRONMENTAL HEALTH SPECIALIST/REGISTERED SANITARIAN
(R.E.H.S./R.S.) APPLICATION
STEP 1: Applicant Information (required)
Name: ________________________________________________________________________________________________________________
Last
First
Middle Initial
Address:
County____________________
Street/PO Box
Social Security Number: ________________
Telephone (Contact):
City
State
- _____________ - ______________
Zip
Date of Birth: _____________/___________/_____________
_______________________________________________
Email: _______________________________________________________
STEP 2: Examination Information (required): Please check the appropriate box(s)

I

I am currently registered in another state (if box is checked, complete the following):
am applying to sit for the R.E.H.S./R.S. exam
Which State?: _______________________________________ Please attach a copy of your current registration
 I have taken either the Professional Examination Service (PES) R.E.H.S./R.S. Examination, the National
Environmental Association (NEHA) R.E.H.S./R.S. examination or another registration examination for
R.E.H.S./R./S. other than the PES or the NEHA examination?
 No, (if no, go to step 3)

Yes (if yes, provide the following information, attach documentation, then proceed to step 3):
Test: _____________________________________________________________ Score: _________________  Pass or Fail
Testing or agency sponsor: __________________________________________________________________
Address of testing or agency sponsor: _______________________________________________________________________
Date Taken_______________________________
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STEP 3: Evidence of Receiving a Baccalaureate or Post-Baccalaureate Degree (required)
Evidence of receiving a baccalaureate or post-baccalaureate degree in environmental health, sanitary science,
sanitary engineering, or other related environmental health field which includes at least 30 semester or 45
quarter credits in the physical or biological sciences is required.
Education Information: Please list all college education credits applicable to registration.
School Name
City and State
Dates
Attended
Degree
Received
Major
Subject
Minor
Subject
Applicable Credit Hours
An official copy of your educational transcripts must be included for processing. You may include an official
copy along with this application or you may have your educational institution mail separately an official copy
of your transcripts to the address provided below:
Minnesota Department of Health
Food, Pools, & Lodging Services Section
Attention: Sanitarian Registration Program
625 Robert Street N.
P.O. Box 64975
St. Paul, MN 55164-0975
For Foreign Applicants:
For foreign applicants or those that have attended and received a university degree outside the United States, a third party
review of your transcripts is necessary to determine equivalency to schools within the United States. The report given by the
third party will need to accompany your application.
 Yes, I can meet the requirement above (please complete step 4 below)
 No, I cannot meet the requirement above. STOP and will apply at a different time when such
requirement can be met.
STEP 4, A: Employment History (required)
A.) Evidence of at least one year of supervised employment that is equal to at least one year of full time
employment in one of more of the environmental health program areas listed below must be meet before you
would be eligible to sit for the R.E.H.S./R.S. exam. Applicable work experience for college credit prior to
earning your degree, (e.g. internship) does not qualify to be counted toward your one year of supervised
employment.
Acceptable Environmental Health Program Areas:
Food, beverage, and lodging sanitation; housing; refuse disposal; water supply sanitation; rodent, insect, and
vermin control; accident prevention; swimming pool and public bathing facility sanitation; radiation safety; air
and water quality, noise pollution, and institutional and industrial hygiene. Implementation includes community
education, investigation, consultation, review of construction plans, collection of samples and interpretation of
laboratory data, enforcement actions, review and recommendation of policy and/or regulation.
 Yes, I can meet the requirement above (please complete step 4, B listed below)
 No, I cannot meet the requirement above. STOP and apply at a different time when all requirements can
be met.
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STEP 4, B: Employment History – Continued (required)
B.) Employment supervision must be provided by a registered environmental health specialist or a sanitarian or
licensed health professional, or an engineer or other professional with a graduate degree in one of the physical
or biological sciences, or other person whom the commissioner deems has equivalent environmental health
background.
 Yes, I can meet the requirement above (please attach a letter from your qualifying supervisor(s) indicating
your name, job title, job duties, date(s) of employment and the hours of employment including full or part time
employment. Also include a copy of your qualifying supervisor(s) credentials). Continue on to step 4,C.
 No, I cannot meet the requirement above. STOP and apply at a different time when such requirement can
be met.
STEP 4, C: Employment History – Continued (required)
C.) List below all employment relevant to registration (most recent employment first). If you require additional
space for employment history, use additional employment box provided below.
Employing firm or agency: _________________________________________________________________________________________
Address:
County____________________
Street/PO Box
City
State
Start Date : _______________________ End Date:_______________
Month/day/year
Zip
 Full-time
 Part -time
Month/day/year
Number of hours per week: ___________________
Job title: ____________________________________
Was this an internship:  Yes  No If yes, was college credit received during your internship:  Yes  No
Describe duties, responsibilities, activities and program areas that apply : _______________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Supervisor’s Name: _________________________________________________________________________
Telephone (Contact):
_______________________________
Email ___________________________________________
Supervisor’s Environmental Health background: __________________________________________________
__________________________________________________________________________________________
Supervisor’s qualifications: (please check one)
 Registered Sanitarian (attach a copy of this credential)
 licensed health professional (attach a copy of this credential)
 an engineer or
 other qualifying professional with a graduate degree in one of the physical or biological sciences (attach a
copy of this credential)
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STEP 4, C: Employment History – Additional Employment (if needed)
 Yes, I have additional employment history that is relevant to registration listed below. (If you require
additional space for employment history, attach additional forms.)
 No, I do not have additional employment history that is relevant to registration – Continue on to step 5
Employing firm or agency: _________________________________________________________________________________________
Address:
County____________________
Street/PO Box
City
State
Start Date : _______________________ End Date:_______________
Month/day/year
Zip
 Full-time  Part -time
Month/day/year
Number of hours per week: ___________________
Job title: ____________________________________
Was this an internship:  Yes  No If yes, was college credit received during your internship:  Yes  No
Describe duties, responsibilities, activities and program areas that apply : _______________________________
__________________________________________________________________________________________
__________________________________________________________________________________________
Supervisor’s Name: _________________________________________________________________________
Telephone (Contact):
_______________________________
Email ___________________________________________
Supervisor’s Environmental Health background: __________________________________________________
_________________________________________________________________________________________
Supervisor’s qualifications: (please check one)
 Registered Sanitarian (attach a copy of this credential)
 licensed health professional (attach a copy of this credential)
 an engineer or
other qualifying professional with a graduate degree in one of the physical or biological sciences (attach a copy
of this credential)
Notice to individuals applying for R.E.H.S./R.S Registration in the State of Minnesota
The commissioner of health will use information provided in this application to determine if you meet the requirements
for Sanitarian Registration. Before the commissioner issues registration to you, Minnesota Statutes, section 270.72,
subdivision 4, requires you to supply your social security number. Other than the social security number, you are not
legally required to provide the requested information. However, submitting false information is grounds for denying your
application or suspending, revoking, or taking other disciplinary action against your registration, if it is issued. Failure to
provide required information may delay the processing of your application or may be grounds for denying your
application.
Under Minnesota Statutes, section 13.41, information you provide on this application, except for your name and address,
is private data while pending. However, in circumstances authorized or required by law, it may be disclosed to others,
including the Attorney General’s Office, the Department of Revenue, and persons contacted for purpose of verification or
investigation. If the matter of your registration becomes contested, the information submitted in this application may
become public. Once you are registered, the information, except for your social security number, becomes public data and
will be part of the agency’s permanent files. – Continue on to step 5
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STEP 5: Payment and Signature (required)
Before this application can be processed, all questions must be answered in their entirety. This application must
be accompanied by:
1. A non-refundable $45 Registration Fee made payable to the Minnesota Department of Health, using a
cashier’s check or money order or personal check. Do not send cash.
2. A $125 exam fee made payable to NEHA, using a second check or money order or personal check. Do
not send cash.
3. Submit application, accompanying documentation and fees to the address listed below:
To those applying for reciprocity or those who have previously taken the Professional Examination
Service Exam and received a score of at least 68%, send only the $45 check or money order for the
registration fee payable to Minnesota Department of Health.
Minnesota Department of Health
Food, Pools, & Lodging Services Section
Attention: Sanitarian Registration Program
625 Robert Street N.
P.O. Box 64975
St. Paul, MN 55164-0975
I certify that the information provided on this application is accurate and complete:
Signature _____________________________________________________
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.
To request this application in another format, call 651/201-5000
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