Local Level Examiner Application

  • Tri-State Region Local Level Examiner Application

  • Format: (000) 000-0000.
  • Are you a USPC Graduate?*
  • Are you currently involved with Pony Club?*
  • I am a:*
  • Please indicate if you are certified in any other equine training programs (choose all that apply):*

  • Testing Interests

    Please let us know what disciplines and levels you are interested in testing.

    Note: when at all possible the region will organize C2 Certifications with a National Examiner.

  • Horse Management only Levels
  • D2/D3 Level Disciplines
  • C1 Level Disciplines
  • C2 Level Disciplines

  • Agreement

    Please refer to the Local Level Examiner Certification Program document for details on the items listed below, and initial below.

  • Date*
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  • Should be Empty: