Student Certification Form

UTD Instructor*

Instructor Email

UTD Instructor Number*

UTD Certification Class*

If other class, please note here:

Certification Date*

Student Name*

First Last

Student Email*

Enter Email Confirm Email

Student's UTD Number (if known)

Student Photo, 2mb max; jpg, png, bmp, jpeg, heic*

Accepted file types: jpg, jpeg, png, bmp, pdf, heic, Max. file size: 2 MB.

STUDENT SKILLS – Buoyancy and Trim Skills*

5 – Excellent / Demonstration Quality

4 – Good Control and Awareness:4 – Good Control and Awareness

3 – Safe but Needs Improvement:3 – Safe but Needs Improvement

2 – Needs Improvement / Not Able to Certify:2 – Needs Improvement / Not Able to Certify

1 – Unsafe / Not Able to Certify:1 – Unsafe / Not Able to Certify

STUDENT SKILLS – Positioning and Situational Awareness*

5 – Excellent / Demonstration Quality

4 – Good Control and Awareness:4 – Good Control and Awareness

3 – Safe but Needs Improvement:3 – Safe but Needs Improvement

2 – Needs Improvement / Not Able to Certify:2 – Needs Improvement / Not Able to Certify

1 – Unsafe / Not Able to Certify:1 – Unsafe / Not Able to Certify

STUDENT SKILLS – Gas Management and Ascent Planning*

5 – Excellent / Demonstration Quality

4 – Good Control and Awareness:4 – Good Control and Awareness

3 – Safe but Needs Improvement:3 – Safe but Needs Improvement

2 – Needs Improvement / Not Able to Certify:2 – Needs Improvement / Not Able to Certify

1 – Unsafe / Not Able to Certify:1 – Unsafe / Not Able to Certify

STUDENT SKILLS – Emergency and Critical Skills Management*

5 – Excellent / Demonstration Quality

4 – Good Control and Awareness:4 – Good Control and Awareness

3 – Safe but Needs Improvement:3 – Safe but Needs Improvement

2 – Needs Improvement / Not Able to Certify:2 – Needs Improvement / Not Able to Certify

1 – Unsafe / Not Able to Certify:1 – Unsafe / Not Able to Certify

THEORETICAL AND ACADEMIC KNOWLEDGE*

5 – Excellent Understanding

4 – Acceptable Understanding

3 – Adequate Understanding

2 – Needs Improvement

1 – Unsafe

Please link to a short video of your student's basic skills (optional).

Is the Student Recommended for Certification?*

Yes

Instructor Comments, Areas for Improvement, etc.

Do you want to purchase a c-card for your student?*

Yes

Mailing address, including name, EXACTLY AS IT SHOULD APPEAR ON THE ENVELOPE FROM THE U.S.

C-CARD price

Price:

Credit Card

Seach for a course, mini or workshop

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