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Certificate of Conformation Assessment CCA EVALUATOR APPLICATION

This form is to apply for CCA event approval. Once approved the events will be submitted to the calendar. The CCA form can be found in PDF format here or you can apply on-line.

Mailing Address:

Robin Bowen
PO Box 884
Hixson TN 3734

CATEGORY 1 or CATEGORY 2

Name
Email
Phone
Address
Address line 2
City/Town
State/Provence
Zip/Postal Code
Country

Please provide the information requested below. (Category 2 Evaluators may be asked to provide records indicating the necessary qualifications.)

CATEGORY 1

I have been approved by AKC or CKC to judge Golden Retrievers since - - (month-day-year)
Date of first Golden Retriever Sweeps/ Match assignment: - - (month-day-year)
My original breed is:

CATEGORY 2

1.	I am a breeder/owner who has spent		years owning/ training/ breeding Golden Retrievers.

I have bred

Golden Retriever litters.

3. I have judged Golden Retriever Sweepstakes or Conformation Matches.
4. Please list how many and the date/ year of first Sweeps/ Match assignment.

5. I have owned at least 5 Golden Retrievers with any of the following titles:

AKC Champion
AKC OTCH or UDX or UD or TDX
AKC MH, SH, or GRCA *** or **
AKC MACH, MX, MXJ, AX, or AXJ
other titles please explain

6. Please list the 5 dogs and indicate by checking the box other dogs you have handled or trained to a portion of their titles.

Dog 1
Dog 2
Dog 3
Dog 4
Dog 5

7. Are you a GRCA member? YES NO If YES, for how many years? If No,

8. If No, AND you are a Canadian Citizen living in Canada, are you a GRCC member?YES NO

If YES, for how many years?

9. Other country of Residence

10. Other Golden Club affiliation

BIOGRAPHY

Both Category 1 and 2 Evaluators please give a brief biography of your involvement with Golden Retrievers that a host club may publish for a CCA Event.

I have read and I understand the latest revision of the GRCA CCA Program Guidelines for Evaluators. I am willing to evaluate each participant against the AKC Breed Standard and I am willing to provide a written assessment of the qualities of each dog I evaluate using the score sheets/report forms provided by the CCA Committee and abide by the guidelines established. I also am willing to provide a verbal critique to the entrant and hands on examination of the dog during my evaluation. I understand that all information regarding individual dogs presented to me shall be kept confidential, sharing it only with the owner or presenter of said dog and within the committee structure of the program.

ACCEPT (checking this box acknowledges that you have read the above text and agree.)

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