Versatility Enrollment Form

Please refer to the Versatility Program Handbook for program information and rules.
Versatility Enrollment Form
Name*

First NameLast Name
Membership Number*
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
E-mail
example@example.com
Phone Number*
Dog's Registered Name*
Dog's Call Name*
How to print Dog's name on Title Certificate?*

Registered NameCall Name
Dog's SCPS Registration Number*
😊 Would you like to submit your first Title with your Enrollment today?*

YesNo
I am applying for the following Title:*

R-IA-IR-IIA-IIR-IIIA-IIIFarm Dog
R-I - 5 Points across 3 Categories.
R-II - 10 Points across 3 Categories.
R-III - 20 Points across 3 Categories.
A-I - 5 Points across all 5 Categories.
A-II - 10 Points across all 5 Categories.
A-III - 20 Points across all 5 Categories.
If you are applying for the Scottish Collie Hero Award, please fill out the top box only of this form and email the judges' panel with your story and documentation. Send to president@scottishcolliepreservationsociety.org.

I will email my nomination for the SCHA to the Versatility Committee.
Categories & Accomplishments

Below, please briefly list your dog's Accomplishments across at least 3 Categories (R-I, R-II, R-III), or 5 Accomplishments across all 5 Categories (A-I, A-II, A-III) for which you are submitting documentation. Please refer to the Handbook for details.
My dog has Accomplishments in the following Categories:

Health and SoundnessHerdingOther Farm/Ranch SkillsOther Work and SportsService, Assistance, and Education
Please list your dog's Accomplishments in Health and Soundness, and any links to documentation:
Please upload an image of each supporting document per Accomplishment in Health and Soundness:

Upload

Cancelof
Please list your dog's Accomplishments in Herding, and any links to documentation:
Please upload an image of each supporting document per Accomplishment in Herding:

Upload

Cancelof
Please list your dog's Accomplishments in Other Farm/Ranch Skills, and any links to documentation:
Please upload an image of each supporting document per Accomplishment in Other Farm/Ranch Skills:

Upload

Cancelof
📌 You have listed Accomplishments in Categories 2 and 3, which means that your dog could be eligible for one of the SCPS Farm Dog Designations. Would you like us to add that to his review?

Yes
Please list your dog's Accomplishments in Other Work and Sports, and any links to documentation:
Please upload an image of each supporting document per Accomplishment in Other Work and Sports:

Upload

Cancelof
Please list your dog's Accomplishments in Service, Assistance, and Education, and any links to documentation:
Please upload an image of each supporting document per Accomplishment in Service, Assistance, and Education:

Upload

Cancelof
Almost Done!

My Products*

Versatility Program Fee$15.00

Total $0.00

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

By submitting this form I agree to abide by the SCPS Code of Ethics and confirm that I am acting in a sportsmanlike manner. I agree that all Versatility Program Title information and documentation that I submit is, to the best of my knowledge, accurate and correct. I acknowledge and agree to pay listed fees to join the program and to receive subsequent titles, as invoiced.
Should be Empty:

Versatility Enrollment Form

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