Submit this form to request to be designated as an instructor qualified to teach educational liquor seminars pursuant to Rifle Municipal Code Section 6-5-170.

Your Name*

Your Company Name

Mailing Address*

City*

State*

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Zip Code*

Telephone*

Email Address*

Website Address

By which national board are you certified?*

To be certified by such national board as an instructor, did you take at least 12 hours of instruction?*

Yes

No

To be certified by such national board as an instructor, did you take a written test?*

Yes

No

To be certified by such national board as an instructor, were you required to score at least 70 percent on this written test?*

Yes

No

How often are you recertified as an instructor by this national board?*

Please attach your certification.*

In what ways is your alcohol training seminar personalized to the City of Rifle and to what the community expects from those who serve or sell alcohol?*

Does your alcohol training seminar cover at least the following: Colorado liquor laws; blood alcohol content; signs and symptoms of intoxication; carding procedures; dealing with difficult patrons; and managers’ policies and responsibilities?*

Yes

No

In order to receive a certificate of completion, must the attendee have actually attended the seminar and achieved a reasonable mastery of the materials presented?*

Yes

No

How do you determine that the attendee has achieved a reasonable mastery of the materials presented?*

Do you issue a certificate to those who successfully complete your alcohol training seminar?*

Yes

No

Does the certificate of completion show the date of completion of the training and the date of certificate expiration?*

Yes

No

For how many years is the certificate of completion valid?*

Do you keep records of attendees who have successfully completed the seminar you teach?*

Yes

No

Will you send those attendance records to the Rifle City Clerk if the City of Rifle approves your alcohol training seminar?*

Yes

No