Club Level Certification Report
This form will accommodate up to 6 candidates.
Club/Center Name
*
Please Select
Bath Pony Club
Brush Run Pony Club
Harts Run Hunt Pony Club
Hunters Run Pony Club
Lost Hounds Pony Club
Rolling Rock Hunt Pony Club
Club/Center Name
Name of Person Submitting Form
*
Email of Person Submitting Form
*
example@example.com
Date of Testing
*
-
Month
-
Day
Year
Date
Is this a second form being completed for the same testing?
*
Yes
No
Was there an Impartial Observer?
*
Yes
No
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Name of Impartial Observer
*
Email
*
example@example.com
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Facility & Examiner Information
Location of Testing
*
Was there a fee to use the facility? If so, please list details below (i.e. flat fee, fee per rider, etc. and total amount paid)
If there was a fee for the facility, who paid for it (i.e. club or candidate.)
Examiner Name
*
Examiner Name (if more than one was hired)
What did you pay the examiner? Please include total amount, and also details on how you determined the total (was there a charge for each section, an hourly or day fee, etc.)
*
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Candidate Details
Name of Candidate
*
Which test(s) were attempted:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
Which test(s) were passed:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
None
Is a retest planned (if needed)?
Yes
No
If yes, please list the sections to be retested and the approximate date of retest:
Is there another candidate?
*
Yes
No
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Name of Candidate #2
*
Which test(s) were attempted:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
Which test(s) were passed:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
None
Is a retest planned (if needed)?
Yes
No
If yes, please list the sections to be retested and the approximate date of retest:
Is there another candidate?
*
Yes
No
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Name of Candidate #3
*
Which test(s) were attempted:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
Which test(s) were passed:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
None
Is a retest planned (if needed)?
Yes
No
If yes, please list the sections to be retested and the approximate date of retest:
Is there another candidate?
*
Yes
No
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Name of Candidate #4
*
Which test(s) were attempted:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
Which test(s) were passed:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
None
Is a retest planned (if needed)?
Yes
No
If yes, please list the sections to be retested and the approximate date of retest:
Is there another candidate?
*
Yes
No
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Name of Candidate #5
*
Which test(s) were attempted:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
Which test(s) were passed:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
None
Is a retest planned (if needed)?
Yes
No
If yes, please list the sections to be retested and the approximate date of retest:
Is there another candidate?
*
Yes
No
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Name of Candidate #6
*
Which test(s) were attempted:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
Which test(s) were passed:
*
D1
D2-HM
D2-DR
D2-EV1
D2-EV2
D2-HSE
D3-HM
D3-DR
D3-EV1
D3-EV2
D3-HSE
C1-DR
C1-HM
C1-EV1
C1-EV2
C1-HSE
C2-HM
C2-DR
C2-EV1
C2-EV2
C2-HSE
None
Is a retest planned (if needed)?
Yes
No
If yes, please list the sections to be retested and the approximate date of retest:
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Test Evaluation
What challenges did you face in planning the testing?
Were there any areas of the testing that were difficult for the candidates?
Submit
Should be Empty: