certified professional soil scientist application incomplete ... or crime for which circumstances...

Certified ProfessionalSoil Scientist

CPSS

Certified Professional Soil ScientistApplication

In order to qualify for certification, one of the two points below must be met (for full CPSS certification, not APSS):

1. Hold a Bachelor’s degree in Soil Science or closely related Agricultural, Earth, or Environmental Science (e.g., a named option in Soil Science, minor in Soil Science) and 5 years of work experience.

Or2. Hold a MS or PhD degree in Soil Science or closely related Agricultural, Earth, or Environmental Science (e.g., a named option in Soil Science, minor in Soil Science) and 3 years of work experience.

If you are applying for the APSS, you must meet the education requirements above and be working toward the work experience requirement.

Note: Incomplete applications will be returned to the applicant without review.

As of February 1, 2012, all new applications received must be on the new application and meet the new requirements.

2

Application for Professional Certification5585 Guilford Road • Madison, WI 53711-5801 • (608) 268-4955 • FAX (608) 273-2081 • www.soils.org/certifications

Have you ever been charged, indicated or convicted of a felony, misdemeanor,or crime for which circumstances relate to being a soil scientist or soil classifier? ❑ Yes ❑ No If yes, attach an explanation.

5. FEES:

Application Fee $75

FEE ENCLOSED $ ______________________ (Fee is non-refundable)

MAKE CHECK PAYABLE TO: SOIL SCIENCE SOCIETY OF AMERICA (Payment must be in U.S. funds)

2. PERSONAL DATA (Completion of this section is optional. Informa tion re-garding specific individual members will not be released.)

Birthdate ______________________ Race ______________________

Citizenship _____________________ Gender ____________________

3. AREA OF CERTIFICATION APPLYING FOR

❑ Currently certified as __________________________ and applying for: (CCA, CCA-CPAg, APSS, or N/A)

Area of Certification

❑ Certified Professional Soil Scientist, CPSS ❑ Associate Professional Soil Scientist, APSS

4. DOCUMENTATION REQUIRED:

a. Completed Core Requirement Form documenting educational background in-cluding: institution, degree(s), major, and minor areas, and course work.

b. An Official Transcript of all academic credits and including verification of degree(s).

c. Completed Professional Experience Form. List all professional positions held, professional activities, and membership and offices held in professional and honorary societies.

d. Completed Core Summary Form.e. Resume.f. Signed and dated Code of Ethicsg. References: 1. For Certified Professional Applications refer to I.B.3. 2. For Associate Professional Applications refer to II.C.1.(3).

The following credit cards are accepted:

❑ MasterCard ❑ Visa ❑ Discover ❑ AMX

Card Number

Expiration Date

Cardholder’s Name

Please Print Name


CPSS

1. APPLICANT’S NAME AND ADDRESSPlease print or type:

❑ Dr. ❑ Mr. ❑ Ms.

Last Name/Surname _______________________________________________________________________________________

First Name/Given Name _______________________________________ Middle Name _____________________________

Address _________________________________________________________________________________________________________________________________

Address __________________________________________________________________________ County (U.S. only) _______________________________________

City ________________________________________ State/Province ________________ Postal Code________________________ Country ______________________

Office Phone ______________________________ Home Phone ___________________________________ FAX ____________________________________________

Cell Phone _______________________________ Email ___________________________________________________________________________________________

Office Use Only

Certification No.

6. NAME TO BE PRINTED ON CERTIFICATE:

Degree following name: (choose only one)—optional

❑ BS ❑ BA ❑ MS ❑ PhD ❑ Other _________________

Last Name/Surname

First Name/Given Name

Middle Name

8. PLEASE LIST NAME AND ADDRESS OF PRESENT EMPLOYER:

9. DIRECTORY OF CONSULTANTS

A directory of certified individuals is located on the web at:http://www.soils.org/certification/directory/

Would you like to be included?

❑ Yes ❑ No

10. SIGNATURE

I hereby certify that all information submitted in support of this application is correct and true to the best of my knowledge and that all information re-garding this application will remain confidential. I have read and signed the Code of Ethics.

Date Signature of Applicant

3

7. PROFESSIONAL EXPERTISE:

Please choose one or more categories in which you can substantiate that you are technically and professionally qualified to practice. Place the category code that you feel the most technically and professionally qualified to prac-tice in the first choice and the next most qualified in the second choice and so on up to four choices.

1. __________ 2. __________ 3. __________ 4. __________

Acid-Sulfate Soils—S2Agricultural Administration—P3Agricultural Climatology—ElAgricultural Development—F2Agro-forestry—X0Agronomic Education—P1Agronomic Management—FlAgronomy (general)—AlBest Management Practices—F4Biometrics—A3Biotechnology—ClCell Biology—C2Computer Assisted Design—B5Computer Modeling—B4Computer Uses—BlConservation Education—P2Conservation Planning, Food Security

Act 1985—F5Comprehensive Nutrient Management—N4Conservation Tillage—D6Crop Breeding—JlCrop Chemistry—K5Crop Cytogenetics—J5Crop Ecology—L1Crop Genetics—J7Crop Marketing—L3Crop Metabolism—KlCrop Physiology—K3Crop Production—L4Crop Protection—L6Crop Quality—O1Crop Science—I1Crop Specialization–Cannery Crops—P4Crop Specialization–Corn—P5Crop Specialization–Cotton—P6Crop Specialization–Grazing—P7Crop Specialization–Rice—P8Crop Specialization–Small Grains—P9Crop Specialization–Soybean—Q2Crop Specialization–Tobacco—Q3Crop Specialization–Tree Fruit—Q4Crop Specialization–Vegetable—Q5Crop Specialization–Wheat—Q6Crop Utilization—O2Cytology—J3Digitized Mapping—B3Edaphology—U3Entomology—L9Environmental Protection—E3Environmental Regulation—E2Ethics—E9Farm Management—F6Farmland Preservation—F3Fertilizer Technology—YlFertilizer Use—Y3Floriculture—H3Floristry—H4Forages—N2Forest Soils—XlGarden Center Management—I7Genetics—J9Greenhouse Production—H2Ground Water Quality—G7Hazardous Waste Management—G2Horticulture (General)—H1Hydric Soils—R4Impact Assessment—E4Information Systems—B2International Agronomy—I4International Horticulture—I6Irrigation—RlIrrigation and Drainage—R2Labor Management—F7Land Classification—V8Land Management—DlLand Resource Analysis—V6

Land Resource Development—V7Land Use—D2Land Use Planning—D5Molecular Cytogenetics—C4Molecular Genetics—C3Nursery Management—I8Nutrient Management—N3Olericulture—H6Organic—O3Ornamental Horticulture—H9Pedology—U6Pest Management—L7Pesticide Use—L8Plant Breeding—J2Plant Chemistry—K6Plant Ecology—L2Plant Cytogenetics—J6Plant Cytology—J4Plant Genetics—J8Plant Metabolism—K2Plant Nutrition—UlPlant Pathology—I5Plant Physiology—K4Plant Propagation—K7Plant Taxonomy—K8Pollution Control—G6Pomology—H5Post-Harvest Physiology—H7Product R&D—W3Range Management—X6Range Soil Science—X3Reclamation—W8Regulatory Admin./Enforcement—E5Regulatory Compliance—E6Resource Conservation—D4Saline Soils—R5Seed Production—MlSeed Technology—M3Small Fruit Culture—I9Soil Biochemistry—TlSoil Chemistry—SlSoil Erosion Sediment Control—W5Soil Fertility—U2Soil Genesis—VlSoil Interpretations—V2Soil Management—W7Soil Microbiology—T2Soil Mineralogy—Z1Soil Morphology/Classification—V3Soil Physics—R3Soil Plant Analysis—U4Soil-Plant Correlation—U7Soil Science—Q1Soil-Water-Plant Relation—U5Soil Resource Inventory—V4Soil Survey—V5Soil and Waste Management—GlSoil and Water Conservation—W1Soil and Water Management—W2Statistical Analysis—B6Streambank Stabilization—W6Surface Mine Reclamation—W4Tissue Culture—C5Tropical Agriculture—I3Tropical Crops—I2Turfgrass Management—NlViticulture—H8Waste Disposal, On-site—G3Waste, Land Treatment/Applic.—G5Waste Management—G4Water Diversion and Control—W9Weed Control—LOWeed Science—L5Wetlands Identification—WOWildlife Management—X2Undefined, Other—Z9

If you have questions on completing this application,please contact Marta Krist at

[email protected]

or at 608-268-4955

4

I, the undersigned, agree to adhere to the above Code of Ethics.

Signature:_________________________________________________________ Date____________________________

Please Print Name__________________________________________________

Article I. Preamble1. The privilege of professional practice imposes obligations of

responsibility as well as professional knowledge. The Soil Science Society of America (SSSA) certifies the credentials of individu-als through the Soils Certifying Board, which is the national soil science certification board. Individuals who meet the requirements for soil science certification will receive the designation of Cer-tified Professional Soil Scientist (CPSS) or Certified Professional Soil Classifier (CPSC). The soil science certification program will only award the title of CPSS/CPSC to individuals who have met the examination, education, experience and ethics requirements as set forth by the SSSA Soils Certifying Board.

2. The Soils Certifying Board will award the title of CPSS to indi-viduals who meet the college education, experience, testing re-quirements, ethics and the continuing education requirements of the Soils Certifying Board. CPSC was no longer issued after 2011. Existing CPSC still apply.

3. A CPSS/CPSC, at the request of a client or employer, must disclose the information used to gain certification. CPSS/CPSC who know-ingly misrepresents their credentials will face disciplinary action.

Article II. Relation of Professional to the Public 1 A CPSS/CPSC shall avoid and discourage sensational, exaggerat-

ed, and/or unwarranted statements that might induce participation in unsound enterprises.

2 A CPSS/CPSC shall not give professional opinion or make a rec-ommendation without being as thoroughly informed as might rea-sonably be expected considering the purpose for which the opinion or recommendation is desired, and the degree of completeness of information upon which the opinion is based should be made clear.

3 A CPSS/CPSC shall not issue a false statement or false information even though directed to do so by employer or client.

Article III. Relation of Professional to Employer and Client

1. A CPSS/CPSC shall protect, to the fullest extent possible, the interest of his/her employer or client insofar as such interest is con-sistent with the law and professional obligations and ethics.

2. A CPSS/CPSC who finds that obligations to their employer or cli-ent conflict with their professional obligation or ethics should work to have such objectionable conditions corrected.

3. A CPSS/CPSC shall not use, directly or indirectly, an employer’s or client’s information in any way that would violate the confidence of the employer or client.

4. CPSS/CPSC retained by one client shall not accept, without the client’s written consent, an engagement by another if the interests of the two are in any manner conflicting.

5. A CPSS/CPSC who has made an investigation for any employer or client shall not seek to profit economically from the informa-tion gained, unless written permission to do so is granted or until it is clear that there can no longer be a conflict of interest with the original employer or client.

6. A CPSS/CPSC shall not divulge information given in confidence. 7. A CPSS/CPSC shall engage, or advise employer or client to en-

gage, and cooperate with other experts and specialists. 8. A CPSS/CPSC protects the interests of a client by recommending

only products and services that are in the best interest of the client and public.

9. A CPSS/CPSC protects his/her credibility by disclosing to clients how he/she will be compensated for providing recommendations to the client.

Article IV. Relation of Professionals to Each Other 1. A CPSS/CPSC shall not falsely or maliciously attempt to injure the

reputation of another. 2. A CPSS/CPSC shall freely give credit for work done by others, to

whom the credit is due, and shall refrain from plagiarism of oral and written communications and shall not knowingly accept credit rightfully due another person.

3. A CPSS/CPSC shall not use the advantage of public employment (i.e., university, government) to compete unfairly with other certi-fied professions.

4. A CPSS/CPSC shall endeavor to cooperate with others in the profession and encourage the ethical dissemination of technical knowledge.

Article V. Duty to the Profession 1. A CPSS/CPSC shall aid in exclusion from certification those who

have not followed this Code of Ethics or who do not have the re-quired education and experience.

2. A CPSS/CPSC shall uphold this Code of Ethics by precept and example and encourage, by counsel and advice, other Registrants to do the same.

3. A CPSS/CPSC having positive knowledge of deviation from this Code by another Registrant shall bring such deviation to the atten-tion of the Soils Certifying Board.

Soils Certifying Board 8/11

SSSA Soils Certifying Board Code of Ethics


CPSS

5

Soil

Scie

nce

Cor

e R

equi

rem

ents

Thi

s fo

rm d

oes

not s

ubst

itut

e fo

r tr

ansc

ript

s, o

ffici

al tr

ansc

ript

s ar

e re

quir

ed.

Cer

tifie

d Pr

ofes

sion

al S

oil S

cien

tist,

5585

Gui

lfor

d R

oad,

Mad

ison

, WI

5371

1-58

01 •

(60

8) 2

68-4

955

FOR

OFF

ICE

USE

No.

Cer

tifi

ed P

rofe

ssio

nal

Soil

Sci

enti

st

CP

SS

Firs

t Nam

e/G

iven

Nam

e

Las

t Nam

e/Su

rnam

e

Deg

ree

Uni

vers

ity

Maj

or

Min

or

I. Pr

ofes

sion

al C

ore

Cou

rse

no.

Dep

t.T

itle

Cre

dit H

ours

Com

pone

ntG

rade

Uni

vers

itySS

SA U

seL

ower

Div

.U

pper

Div

.L

abor

ator

yFi

eld

Soil

Gen

esis

, M

orph

olog

y, &

C

lass

ifica

tion

Soil

Che

mis

try

&

Min

eral

ogy

Pro

fess

iona

l Cor

e R

equi

rem

ents

incl

ude:

• >

15

sem

este

r cr

edits

tota

l of

whi

ch >

9 s

emes

ter

cred

its m

ust b

e up

per

divi

sion

•

Low

er d

ivis

ion=

Fres

hman

and

sop

hom

ore

leve

l cou

rses

. •

Upp

er d

ivis

ion=

Juni

or, s

enio

r, an

d gr

adua

te le

vel c

ours

es.

• I

n th

e co

mpo

nent

col

umn,

put

an

X in

eith

er th

e la

bora

tory

or

field

col

umn

that

bes

t des

crib

es th

e co

urse

•

Lab

orat

ory

and/

or F

ield

cou

rsew

ork

is a

req

uire

d co

mpo

nent

in >

2 o

f th

e so

il Sc

ienc

e C

ore

clas

ses.

Exa

mpl

es in

clud

ing

soil

judg

ing,

und

ergr

adua

te r

esea

rch,

labo

rato

ry e

xer-

cise

s, fi

eld

cour

ses.

•

A m

inim

um g

rade

poi

nt a

vera

ge (

GPA

) of

2.5

is r

equi

red

in th

e to

tal p

rofe

ssio

nal c

ore

cour

se

requ

irem

ent.

Thi

s do

es n

ot in

clud

e th

e su

ppor

ting

core

cou

rses

. •

In

the

cred

it ho

urs

colu

mn,

indi

cate

if th

ey a

re s

emes

ter

or q

uart

er h

ours

(e

x 3

Sem

or

3 Q

tr).

6I. Pr

ofes

sion

al C

ore

Cou

rse

no.

Dep

t.T

itle

Cre

dit H

ours

Com

pone

ntG

rade

Uni

vers

itySS

SA U

seL

ower

Div

.U

pper

Div

.L

abor

ator

yFi

eld

Soil

Fer

tilit

y &

Nut

rien

t M

anag

emen

t

Soil

Phy

sics

Soil

Bio

logy

&So

il E

colo

gy

Soils

& L

and

Use

M

anag

emen

t

(For

est S

oils

, So

il C

onse

rvat

ion,

Ero

sion

&

Sedi

men

t Con

trol

,E

nvir

onm

enta

l Soi

l Sci

ence

, W

etla

nd S

oils

, Urb

an S

oils

)

Las

t Nam

e/Su

rnam

e___

____

____

____

____

____

____

____

____

___

7

II. S

uppo

rting

Cor

eC

ours

e no

.D

ept.

Titl

e C

redi

t Hou

rsG

rade

Uni

vers

itySS

SA U

seL

ower

Div

.U

pper

Div

.

Agr

icul

tura

l Sci

ence

(Agr

onom

y, C

rop

Scie

nce,

A

grof

ores

ty, H

ortic

ultu

re,

Prec

isio

n A

gric

ultu

re,

Sust

aina

ble

Agr

icul

ture

, R

ange

Sci

ence

, Tur

f Sc

ienc

e,

Wee

d Sc

ienc

e)

Bio

logi

cal &

Eco

logi

cal

Scie

nces

(Bio

logy

, Bot

any,

Eco

logy

, Fo

rest

ry, M

icro

biol

ogy,

R

ange

Sci

ence

, Wet

land

Sc

ienc

e)

Che

mis

try,

M

athe

mat

ics,

Phy

sics

, St

atis

tics

Com

mun

icat

ions

(Spe

ech,

Tec

hnic

al W

ritin

g)

Las

t Nam

e/Su

rnam

e___

____

____

____

____

____

____

____

____

____

_Su

ppor

ting

Cor

e R

equi

rem

ents

Inc

lude

:

• >

45

sem

este

r cr

edits

tota

l of

whi

ch >

15

sem

este

r cr

edits

mus

t be

uppe

r di

visi

on.

• L

ower

div

isio

n=Fr

eshm

an a

nd s

opho

mor

e le

vel c

ours

es. U

pper

div

isio

n=Ju

nior

, Sen

ior,

and

grad

uate

cou

rses

.

• 4

of

the

follo

win

g 8

area

s m

ust

have

> 5

cre

dits

.

• E

xam

ples

are

pro

vide

d fo

r ea

ch c

ateg

ory

• I

f yo

u ar

e sh

ort c

redi

ts, y

our

appl

icat

ion

will

be

reje

cted

unl

ess

you

prov

ide

a w

ritte

n ex

plan

a-tio

n of

oth

er c

ours

es/e

xper

ienc

e to

ful

fill t

he m

issi

ng c

redi

t req

uire

men

t(s)

.

8

II. S

uppo

rting

Cor

eC

ours

e no

.D

ept.

Titl

e C

redi

t Hou

rsG

rade

Uni

vers

itySS

SA U

seL

ower

Div

.U

pper

Div

.

Geo

scie

nce

Scie

nce

(Arc

heol

ogy,

Phy

sica

l Geo

g-ra

phy,

Geo

grap

hic

Info

rma-

tion

Syst

ems,

Met

eoro

logy

, R

emot

e Se

nsin

g, T

erra

in

Ana

lysi

s, &

Atm

osph

eric

Sc

ienc

e)

Hum

an H

ealt

h &

L

and

Use

(Env

iron

men

tal L

aw &

Po

licy,

Env

iron

men

tal E

thic

s &

Phi

loso

phy,

Env

iron

men

tal

Qua

lity,

Haz

ards

, Lan

d U

se

Plan

ning

, Site

Ass

essm

ent,

Sust

aina

bilit

y, T

oxic

olog

y,

Was

te M

anag

emen

t,

HA

ZW

OPE

R)

Tech

nolo

gy &

E

ngin

eeri

ng(A

gric

ultu

ral E

ngin

eeri

ng,

Bio

engi

neer

ing

Soil,

Civ

il,

Con

stru

ctio

n &

Geo

tech

nica

l E

ngin

eeri

ng,

Env

iron

men

tal E

ngin

eeri

ng,

Irri

gatio

n Te

chno

logy

, C

ompu

ter

Aid

ed D

raft

ing)

Wat

er S

cien

ces

(Hyd

rolo

gy, H

ydro

geol

ogy,

L

imno

logy

, Wat

er R

esou

rces

, V

ados

e Z

one,

Wet

land

Sc

ienc

e)

Las

t Nam

e/Su

rnam

e___

____

____

____

____

____

____

____

____

____

____

__

9

EX

AM

PL

E

Prof

essi

onal

Wor

k E

xper

ienc

e Fo

rmSO

IL S

CIE

NC

E C

ER

TIF

ICA

TIO

N

INST

RU

CT

ION

S1.

L

ist f

ull-

time

posi

tions

in s

eque

ntia

l ord

er, e

ndin

g w

ith c

urre

nt p

ositi

on.

2. L

ist

only

pro

fess

iona

l-le

vel

posi

tions

in

the

area

of

soil

scie

nce

beyo

nd t

he b

ac ca

laur

e ate

deg

ree.

W

ork

expe

rien

ce w

hile

obt

aini

ng a

n ad

vanc

ed d

egre

e sh

ould

not

be

incl

uded

.3.

Lis

t beg

inni

ng a

nd e

ndin

g m

onth

and

yea

r fo

r al

l pos

ition

s.4.

If y

ou h

ave

wor

ked

in tw

o po

sitio

ns c

oncu

rren

tly, i

ndic

ate

unde

r the

per

cent

tim

e ca

tego

ry th

e ye

arly

pe

rcen

tage

tim

e yo

u w

orke

d in

eac

h po

sitio

n.

5. S

how

the

perc

ent t

ime

on a

n an

nual

bas

is f

or e

ach

wor

k ac

tivity

(sh

ould

tota

l 100

%).

6. U

nder

ref

eren

ce, l

ist t

he r

efer

ence

(s)

mos

t fam

iliar

with

eac

h w

ork

expe

rien

ce.

7. D

utie

s an

d re

spon

sibi

litie

s sh

ould

be

spec

ific

and

det

aile

d.8.

Be

sure

to to

tal m

onth

s of

exp

erie

nce.

R

emem

ber

wor

k ex

peri

ence

gai

ned

whi

le s

eeki

ng a

deg

ree

does

not

cou

nt t

owar

d th

e C

PSS

/SC

w

ork

expe

rien

ce r

equi

rem

ent.

9. C

opy/

prin

t add

ition

al p

ages

if n

eede

d.

EX

AM

PL

E

Em

ploy

men

t Inf

orm

atio

n

L

engt

h D

egre

e E

mpl

oyer

P

rofe

ssio

nal

%

%

Tim

e/

Fro

m

To

L

evel

N

ame,

Loc

atio

n T

itle

T

ime

Dut

ies

and

Res

pons

ibili

ties

A

ctiv

ity

Ref

eren

ce

9/

88–9

/90

BS

Dav

is E

ngin

eeri

ng

Soil

Scie

ntis

t 10

0 D

elin

eate

hyd

ric

soils

on

pote

ntia

l hig

hway

Polly

Ped

on

Cul

pepe

r, V

A

rig

ht o

f w

ays

50

John

Mud

d

D

escr

ibe

soils

on

arch

aeol

ogy

site

s to

mee

t

Dav

id A

uger

env

iron

men

tal i

mpa

ct r

equi

rem

ents

5

W

illia

m P

rofi

le

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11

12

5585 Guilford Road • Madison, WI 53711-5801 • 608-268-4955 • FAX 608-273-2081

Certification Programs

Certified Professional Soil Scientist sponsored by the Soil Science Society of America

www.soils.org/certifications

From: ___________________________________ To: ___________________________________ Applicant’s Name Reference’s Name

____________________________________ ___________________________________ Applicant’s Address Reference’s Address

____________________________________ ___________________________________

____________________________________ ___________________________________

____________________________________ ___________________________________ Applicant’s phone number Reference’s Phone Number

AREA OF CERTIFICATION APPLYING FOR:

❑ Certified Professional Soil Scientist (CPSS)

❑ Associate Professional Soil Scientist (APSS)

Note to Applicant: Please complete the above information and give this form to the reference. The reference needs to complete the questions on the reverse side and forward to the SSSA Offices (see below).

Note to Reference: The above-named individual is applying for certification and has requested that you act as a reference. An applicant must provide at least five references (including at least one that is a CPSS or CPAg, a licensed soil scientist, or a faculty member familiar with the applicants work experience in soil science, as refer-enced in I.B.3 of the CPSS Policy Document), and others who are familiar with her/his experience. By completing this form you will be acting as a reference for the applicant named above.

Please answer the questions on the back of this form, and include any additional comments that you feel may be helpful. This form will be reviewed by the Certifying Board to ensure that the applicant has the necessary educa-tion and experience to be certified.

Prospective applicants must meet rigorous educational, experience, and ethical standards. They must have a mini-mum of a Bachelor's level degree, meet certain course requirements, and adhere to the code of ethics. No experi-ence is required for Associate Professional (AP) status.

Because we want to certify only individuals who meet the professional standards, we solicit your confidential and frank opinion of this applicant.

Experience: Applicants for Certified Professional status (no experience is needed for Associate Professional status) must have at least five years of professional experience beyond the baccalaureate degree in each area of certification. An advanced degree will substitute for two years professional experience; for example three years of professional experience at both the MS and/or PhD level.

Reference Request


CPSS

Check if reference is:

❑ CPSS ❑ CPAg

❑ Licensed Soil Scientist (State)________________________

❑ Soil Science Faculty

Please sign and return this form (2 pages) directly to: Marta Krist at [email protected] or mail toSSSA Certification Department, 5585 Guilford Road, Madison, WI 53711-5801 or fax to 608-273-2081

*Reference letters sent to the applicant will not be considered.

13

Please respond to the following items and include any pertinent information that you feel will aid in the evaluation of the applicant’s credentials.

1. In what capacity have you had association with the applicant(family members/relatives not valid references)?I am (was) the applicant’s:

_____ Supervisor _____ Subordinate _____ Academic Advisor _____ Colleague _____ Classmate _____ Client _____ Other as: ______________________

2. What length of time have you known the applicant in the above capacity? _________________ years

3. For what period of time are you familiar with the applicant’s professional work experience? From _________________ to ________________ month/year month/year

4. Knowing the minimum requirements for certification, do you feel qualified to recommend this applicant to become certified in the area of certification as stated on the reverse side? ________ Yes ________ No

If “yes”, please proceed and complete the reference. If “no”, please give a brief statement in # 7 below of your reason(s); sign and return this letter immediately.

5. What particular strengths do you feel the applicant has that may be important in the evaluation of a professional?

___________________________________________________________________________________________________

___________________________________________________________________________________________________

6. Do you feel that the applicant is fully qualified at this time for the certification listed? ________ Yes ________ No If no, how could the applicant overcome any weaknesses or deficiencies?

___________________________________________________________________________________________________

___________________________________________________________________________________________________

7. Please comment on the applicant’s professional growth and development, ability to analyze and solve problems, resourceful-ness, professionalism, and knowledge in the area of application. Also, please make any additional comments which will aid in making a fair evaluation of this applicant.

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

8. Do you recommend this applicant to be certified in the area of certification as stated on the reverse side? ____ Yes ____ No

Your response will remain confidential.Print Name _____________________________________________________________________________________________

Signature ________________________________________________ Professional Title ________________________________

Employer _________________________________________ Location ______________________________________________

Date _________________ Licensed or Certified as _________________________ Telephone ___________________________

Email _________________________________________________________________________________________________



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certified professional soil scientist application incomplete ... or crime for which circumstances...

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