Local Level Examiner Application

Please indicate if you are certified in any other equine training programs (choose all that apply):*

Eventing Coaches ProgramUSDF Instructor CertificationUSHJA Instructor CredentialedOther
Eventing Coaches Program Level*
USDF Instructor Certification Level*
List any other qualifications you feel are an asset to being an examiner. Please include your ICP/USDF level if applicable.*

Agreement

Please refer to the Local Level Examiner Certification Program document for details on the items listed below, and initial below.
I agree to review the educational materials (available online).*

Clear
I agree to complete the required safety training & provide proof of completion.*

Clear
I agree to provide a First Aid Certification card.*

Clear
I understand the hands-on training requirement.*

Clear
I understand that continuing education is required to maintain my knowledge level and to remain on the LLE roster.*

Clear
Signature*

Clear
Date*

MonthDayYear
Date
Should be Empty:

Tri-State Region Local Level Examiner Application