VRPC Club-Level Testing Report
Please submit the following information within 14 days of the rating date. If more than four (4) member certificate candidates were tested at a single testing, a second form will need to be submitted and non-required fields will not need to be populated a second time. If a candidate tested more than one level during the testing, please enter each level tested as a separate certificate candidate. If a candidate was retesting please mark so under candidate testing type. Thank You!
Club *
Rating Date *
mm/dd/yyyy
Your answer
Testing Location *
Your answer
Examiner *
Last, First
Your answer
Testing Assistant(s) or Scribe(s)
Please list all who assisted with the testing
Your answer
DC or Club Representative Present *
Your answer
Impartial Observer *
Your answer
Fee Paid *
Include whether fee schedule was per hour or per candidate
Your answer
Testing Summary
Certificate Level Testing Performed *
Check all that apply
Required
Indicate the rating(s) start time and duration *
Include breakout if separate levels were tested individually
Your answer
Overall evaluation of candidate skills preparation
Comments required if candidate(s) did not pass
Your answer
Special Circumstances
Weather, facility issues, mount issues, etc
Your answer
Examiner Evaluation
Would the Club be willing to use this examiner again? Comments?
Your answer
Certificate Candidate 1
Candidate 1 *
Last, First
Your answer
Candidate 1 Testing Type *
Either Classic or Alternate Rating Progression (can select more than one ARP phase)
Required
Candidate 1 Certificate Level Tested *
Candidate 1 Passed? *
Candidate 1 Retest?
If yes, sections to be retested must be completed within 30 days
Candidate 1 Sections to be Retested
If candidate has sections to retest, which sections are being retested?
Your answer
Certificate Candidate 2
Candidate 2
Last, First
Your answer
Candidate 2 Testing Type
Either Classic or Alternate Rating Progression (can select more than one ARP phase)
Candidate 2 Certificate Level Tested
Candidate 2 Passed?
Candidate 2 Retest?
If yes, sections to be retested must be completed within 30 days
Candidate 2 Sections to be Retested
If candidate has sections to retest, which sections are being retested?
Your answer
Certificate Candidate 3
Candidate 3
Last, First
Your answer
Candidate 3 Testing Type
Either Classic or Alternate Rating Progression (can select more than one ARP phase)
Candidate 3 Certificate Level Tested
Candidate 3 Passed?
Candidate 3 Retest?
If yes, sections to be retested must be completed within 30 days
Candidate 3 Sections to be Retested
If candidate has sections to retest, which sections are being retested?
Your answer
Certificate Candidate 4
Candidate 4
Last, First
Your answer
Candidate 4 Testing Type
Either Classic or Alternate Rating Progression (can select more than one ARP phase)
Candidate 4 Certificate Level Tested
Candidate 4 Passed?
Candidate 4 Retest?
If yes, sections to be retested must be completed within 30 days
Candidate 4 Sections to be Retested
If candidate has sections to retest, which sections are being retested?
Your answer
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