GRCA CCA Evaluator Application This form is to apply to become a CCA Evaluator. When approved, a DVD that fully explains the program will be mailed to the applicant. In the interim, please read about the program on grca.org under Events. Mailing Address: Joanne Cava. 226 First Place, Fort Mill, SC 29707Please choose one. (Before selecting, read Requirements For Evaluators in the Certificate of Conformation (CCA) Program Outline) Category 1 Category 2 Name* First Last Email* PhoneAddress Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide the information requested below. (Category 2 Evaluators may be asked to provide records indicating the necessary qualifications.)Category 1I have been approved by AKC CKC To judge Golden Retrievers since MM slash DD slash YYYY Date of first Golden Retriever Sweeps/Match Assignment MM slash DD slash YYYY My original breed is:Category 2I am a breeder/owner. True Years I have spent owning/training/breeding Golden RetrieversGolden Retriever litters I have bredI have judged Golden Retriever Sweepstakes or Conformation Matches True Please list how many and the date/ year of first Sweeps/ Match assignment.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 True Dog 1Dog 2Dog 3Dog 4Dog 5Are you a GRCA member?YesNoFor how many years?If No, AND you are a Canadian Citizen living in Canada, are you a GRCC member?YesNoIf YES, for how many years?Other Country of ResidenceOther Golden Club affiliationBiographyBoth 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.) CAPTCHAPhoneThis field is for validation purposes and should be left unchanged.