Evaluation Request FormHomeTrainingEvaluation Request FormCompanyPlease complete the evaluation request form at least 90 days prior to the start of the course you would like to be evaluated at.Name — First *Name — Last *Email *PhoneStart date of the course you wish to instructCourse you will be instructing *Select…(blank)Advanced Roadside Hazardous Materials InspectionCargo Tank InspectionGeneral Hazardous Materials InspectionInvestigative Safety AnalysisNew Entrant Safety AuditNew Entrant Safety Audit WorkshopNorth American Standard Inspection Part ANorth American Standard Inspection Part BOther Bulk Packaging InspectionPassenger Carrier Vehicle InspectionCity *State / Province *Supervisor name — First *Supervisor name — Last *Supervisor email *Additional InformationI have read and understand the confirmation below and I concent to being evaluated. *I am requesting my performance be evaluated for certification purposes. <p></p>I confirm that I have successfully completed all steps and requirements outlined in the Instructor Certification Program prior to requesting a field evaluation. <p></p>Furthermore, I understand that granting my request is contingent upon evaluator availability and CVSA approval. <p></p>Additionally, I understand my presentation during my field evaluation may be captured via video and used by CVSA for evaluation and training purposes. <p></p>I am submitting this request at least 90 days prior to the start of the course.Submit
