Application for National Referee Exam

USA Powerlifting Referee Requirements and Procedures (Effective January 1, 2020)

Name *

First Name Last Name

State *

USA Powerlifting Membership Number (must be a current member) *

Email *

Confirmation Email Confirm email address

Date (month and year) that the rank of state referee was obtained *

State Chair's name *

Has your state chair given approval for you to take your test? *

Yes No

Have you completed SafeSport training? *

Yes No

Has your background check been completed? *

Yes No

Have you gone through drug testing training? *

Yes No

In order to sit for the national exam, candidates must have been a referee for an entire session at 6 different full power events (must have been chief referee at 2 of those events). Please list those 6 events and your referee position for each below."

Local/State Event #1 (as chief referee): Year and event name *

Local/State Event #1 (as chief referee): Served as chief referee for full session *

Yes No

Local/State Event #2 (as chief referee): Year and event name *

Local/State Event #2 (as chief referee): Served as chief referee for full session *

Yes No

Local/State/Regional Event #3 (served as chief or side referee for full session) *

Year and event name

Local/State/Regional Event #3 (as chief or side referee): *

Chief Side

Local/State/Regional Event #4 (served as chief or side referee for full session) *

Year and event name

Local/State/Regional Event #4 (as chief or side referee): *

Chief Side

Local/State/Regional Event #5 (served as chief or side referee for full session) *

Year and event name

Local/State/Regional Event #5 (as chief or side referee): *

Chief Side

Local/State/Regional Event #6 (served as chief or side referee for full session) *

Year and event name

Local/State/Regional Event #6 (as chief or side referee): *

Chief Side

How many total meets have you refereed? *

The USA Powrlifting competition calendar can be found at

USA Powerlifting Event Calendar

Use the information from the USA Powerlifting competition calendar to answer the following question.

Please list the event (name and location) at which you want to take your National test. *

Electronic Signature

By signing below, I agree to the following terms:

- I affirm that I meet all of the requirements to take the national referee exam

- I affirm that all of the information I provided in this form is accurate and truthful

- I understand that this form must be submitted at least 30 days prior to my exam date

- I understand that I must referee at a national meet within 12 months of passing the national referee exam in order to officially be given the national referee rank

- I understand that in order to maintain my national referee rank, I must referee at a minimum of 2 national events every 4 years (based on the IPF referee certification cycle: 2020-2023, 2024-2027, etc.); failure to do so will result in revocation of my national referee rank

Signature *

Clear

Please send any questions or concerns to the following email: referee@usapowerlifting.com