CPSI Course Instructor Application - Professional Reference Form

The below stated person has applied to be an instructor for the National Recreation and Park Association’s Certified Playground Safety Inspector Course. Three professional references are required in the application process. Please answer all questions completely. The completed reference form will remain confidential. If you have any additional questions, please contact the Playground Safety Manager at (703) 858-4749 or email llee@nrpa.org. Thank you.

1. Applicant’s Name: *This question is required.

2. Your Information:

Your Name: *This question is required.

Title: *This question is required.

Company/Agency Name: *This question is required.

Street Address:

Apt/Suite/Office:

City:

State:

Zip:

Email Address: *This question is required. This question requires a valid email address.

Phone Number: *This question is required.

Relationship to Applicant: *This question is required.

Number of years you've known the applicant: *This question is required. This question requires a valid number format.

3. Please complete the following: I __________ recommend this applicant as an instructor for the CPSI course. *This question is required.