To use this form, you must be a CPoCUS Master Instructor in the same track as the applicant's request.
Asterisk denotes required answer.

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* 1. Please enter today's date.

Date

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* 2. Please enter your name.

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* 3. Please enter your IP number.

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* 4. Please select the track in which you are a Master Instructor (MI) (check all that apply).

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* 5. Please enter the name of the Exception to IP Certification candidate.

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* 6. Please indicate how long you have known the Exception candidate.

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* 7. Please select which track the Exception candidate has applied for (check all that apply).

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* 8. I attest that the Exception candidate successfully passed the written, practical, and visual exams for this (these) track(s).

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* 9. Additional comments regarding the Exception candidate.

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* 10. Additional material (optional).

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