NSSA NSSA Level 3
Instructor Course Application
 
NSSA Number:
First Name:
Middle Initial:
Last Name:
Address 1:
Address 2:
City:
State:
Zip Code:
Cell Phone:
EMail Address:
DOB:
Current NSSA Class:
Highest NSSA Class:
How long have you been a Level 2 Instructor?  Years:   Months
How many documented instruction hours do you have AS A LEVEL 2 Instructor*?
* Must be "clocked Hours", i.e. 2 hours teaching 3 students is 2 hours, Not 6 hours *
Course location and date you are requesting:

Costs: $500.00. - You will also be responsible for the following additional costs: personal target fees and the certifying instructor's travel expenses (each candidate will pay an equal share of the certifying instructor's travel expenses)..

Shooters are responsible for: Shotgun, ammunition, eye & ear protection, shell pouch or vest. Course material will be provided by the instructor. Shooter must provide the Chief Instructor a copy of their journal with all their Level 2 Instruction hours before taking the course.

*All applicants MUST complete the Background Check Agreement with their application.

*Membership must be with NSSA. NSCA members shooting NSSA targets under the Crossfire Program do not qualify. Be sure to pay for the NSSA membership before the course's sign-up deadline.

Note: Only enter the information of the person that is signing up for the course, not the contact information of the person paying (in many cases, this will be the same person).

Falsification of the above information will result in disqualification and the return of all prizes and monies for all events. Falsification of classification information could also lead to suspension from the NSSA.

I Agree with the above Disclaimer*