Referee Academy - 2018/2019 Application Form

Personal Details
Name *

Forename Surname
Date of Birth: *

Day Month Year
Your Parent County FA *
Please type the full name of the CFA and do not abbreviate. For example, you should write 'London FA' and not 'LFA'.
Your FA number (FAN) *
Contains numbers only.
Your 2020/2021 Affiliation Number *
This will commence 'WR0...' and you can find it in the 'Referee Administration' section within the WGS.
Current Level *
If you are on promotion, please select the relevant option
Disability

Please tick if you consider yourself to have a disability - if you do, it is important we know, so that we can support you as best as possible.
If you have ticked the box above please tick in all the boxes that apply to you:

Visual impairment Hearing impairment Mental health problems Physical disability Learning disability

Applicant Declaration
I hereby declare that none of the information in this application form is false or misleading. I understand that;
- I will need to maintain up-to-date availability on 'PITCHSIDE', as I understand that this is how the KYL will formally notify me that I have an appointment.
- I also understand that I MUST HAVE an in-date FA CRC as well as an in-date Safeguarding qualification recorded on my FAN; without these I understand that I WILL NOT be offered any appointments.
- I also understand that any match-based discipline MUST BE SUBMITTED within 48 working hours. Failure to do so may lead to disciplinary action being taken against me by my Parent CFA.
Signature of applicant *

Clear
Date *

Day Month Year
Should be Empty:

Match Official Sign-Up