Ssi referral form 2026

1. Click ‘Get Form’ to open the ssi referral form in the editor.
2. Begin by filling out the Student Information section. Enter the student's name, address, city, state/province, zip/postal code, phone number, date of birth, height, weight, and gender.
3. In Part 1 — Initiating Instructor, certify that you are an active instructor. Fill in the date training was completed and exam score. Provide your name, dealer name, address, phone number, fax number (if applicable), email address, and sign with the date.
4. Follow the directions provided for medical history. Ensure to include a copy of the student’s Medical History form in the Universal Referral Packet if required.
5. In Part 2 — Referral Instructor, review the Medical History form and log dives in the Student’s Dive Log. Complete all necessary records and sign a Waiver and Release of Liability form as instructed.
6. After successful completion of training dives, sign this form and ensure all copies are distributed correctly as per instructions.

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