Your Name (required)

Your Email (required)

Subject

Organization Name*

Organization WebSite*

Organization Address*

City *

State/Province
[text* State/Province]

Country *

Postal Code

Main Office City *

Phone Number *

Type Of Activity *
Check all that apply
LSS TrainingLSS CoachingLSS ConsultingLSS Certification

Training Programs *
Check all that apply
LSS White BeltLSS Yellow BeltLSS Green BeltLSS Black BeltSponsor and/or Champion TrainingLSS Implementation and DeploymentDFSSProject ManagementChange Management

LSS White Belt Training Hours *
choose the closest answer
WB Training less than 4WB Training 4 hoursWB Training 8 hoursWB Training more

LSS Yellow Belt Training Hours *
choose the closest answer
YB Training 24 hoursYB Training 32 hoursYB Training 40 hours

LSS Green Belt Training Hours *
choose the closest answer
GB training 48 hoursGB training 64 hoursGB training 80 hours

LSS Black Belt Training Hours *
choose the closest answer
BB training 120 hoursBB training 144 hoursBB training 160 hours

Type Of Training Provided *
check all that applied
Training Onsite / ClassroomTraining Public / ClassroomOnline

GB Project Required *
GB project NoGB project Yes

GB Exam Required *
GB exam noGB Exam Yes

BB Project Required *
BB project NoBB, 1 ProjectBB, 2 Projects

BB Exam Required *
BB exam NoBB exam 1 exam

Top 3-5 Customers and Industry *

customer/industry/type of training

Training Provided For School / College / Universty *

school/program

Strategic Partners *

please list

Certification Process *

List the certification steps

Organization Years Of Operation *

Number Of Instructors *

I Will Submit a 20-30 Slides Sample Of The Training Material *
NoYes

I Will Contact customerservice@aslss.com to purchase the $135 Evaluation From ASLSS *
NoYes

If Eligible For The ASLSS Accreditation I Would Like To Receive It By *
EmailMailCourier

How did you hear about us?
GoogleFriendsOthers

I hereby confirm
name/title/date

Disclaimer:The ASLSS accreditation is not a license. It is the professional equivalent to peer recognition, that a program or organization has demonstrated proficiency in providing Lean Six Sigma training and certification.