USSF/SCRA Supplemental Match Report
Name of person filing Report
*
First Name
Last Name
Your E-mail
*
example@example.com
Your Phone Number (Best to call)
*
USSF Affiliated game?
*
Yes
No
Arbiter game number?
*
Select League. (Enter Tournament name below)
*
SOCAL
CSL
ESL
LNFA
ECNL/ECRL
City of Irvine
San Clemente Coed
EAL
NPL
GA/DPL
E64
Tournament
Other
If Tournament, enter tournament name?
Game Date
*
-
Month
-
Day
Year
Date
Scheduled kickoff time?
*
Hour Minutes
AM
PM
AM/PM Option
Venue/Field? (example OC Great Park #7)
*
Gender?
*
Boys/Men
Girls/Women
Coed
Division/Age Group?
*
Adult
U18/U19
U17
U16
U15
U14
U13
U12
U11
U10
U9
U8
U7
Home Team
*
Away Team
*
Home Score (Final)
*
Away Score (Final)
*
Center Referee Name
*
Center referee Grade?
*
Grassroots (7,8,9)
Regional (5, 6)
Emeritus (15, 16)
National
Center Referee USSF ID # (Last 4)
*
AR1 Name
*
AR1 Grade?
Grassroots (7,8,9)
Regional (5, 6)
Emeritus (15, 16)
National
AR1 USSF ID # (Last 4)
AR2 Name
*
AR2 Grade?
Grassroots (7,8,9)
Regional (5, 6)
Emeritus (15, 16)
National
AR2 USSF ID # (Last 4)
Caution 1 Name
Caution 1 Team and jersey #
Reason for Caution 1
Unsporting Behavior (UB)
Persistent Infringement
Delay of game
Dissent
Leave/Enter field without permission
Fails to respect required distance
Caution 2 Name
Reason for Caution 2
Unsporting Behavior (UB)
Persistent Infringement
Delay of game
Dissent
Leave/Enter field without permission
Fails to respect required distance
Caution 2 Team and jersey #
Caution 3 Name
Caution 3 Team and jersey #
Reason for Caution 3
Unsporting Behavior (UB)
Persistent Infringement
Delay of game
Dissent
Leave/Enter field without permission
Fails to respect required distance
Caution 4 Name
Caution 4 Team and jersey #
Reason for Caution 4
Unsporting Behavior (UB)
Persistent Infringement
Delay of game
Dissent
Leave/Enter field without permission
Fails to respect required distance
Caution 5 Name
Caution 5 Team and jersey #
Reason for Caution 5
Unsporting Behavior (UB)
Persistent Infringement
Delay of game
Dissent
Leave/Enter field without permission
Fails to respect required distance
Caution 6 Name
Caution 6 Team and jersey #
Reason for Caution 6
Unsporting Behavior (UB)
Persistent Infringement
Delay of game
Dissent
Leave/Enter field without permission
Fails to respect required distance
Send Off 1 Name
Send Off 1 Team and jersey #
Reason for Send Off 1
Second Caution
Serious Foul Play (SFP)
Spitting
Violent Conduct (VC)
Referee Assault
DOGSO foul
DOGSO Handling
Offensive/Insulting/Abusive Language
Irresponsible behavior (Coach or bench personnel only
Referee Abuse
Send Off 2 Name
Send Off 2 Team and jersey #
Reason for Send Off 2
Second Caution
Serious Foul Play (SFP)
Spitting
Violent Conduct (VC)
Referee Assault
DOGSO Foul
DOGSO Handling
Offensive/Insulting/Abusive Language
Irresponsible behavior (Coach or bench personnel only
Referee Abuse
Send Off 3 Name
Send Off 3 Team and jersey #
Reason for Send Off 3
Second Caution
Serious Foul Play (SFP)
Spitting
Violent Conduct (VC)
Referee Assault
DOGSO Foul
DOGSO Handling
Offensive/Insulting/Abusive Language
Irresponsible behavior (Coach or bench personnel only)
Referee Abuse
Describe in detail any injuries, cautions, or send offs
*
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