2021 Young Referee of the Year Nomination

This form is designed to allow you build a nomination package online by submitting information and documents as they become available. You will be provided a link to return to this form to edit or add to your submission.

Deadline for completion of the nomination package is August 31, 2021, in order to allow SRC review prior to submission to VYSA on September 10, 2021.

An individual may be nominated and selected as the Young Female Referee of the Year or the Young Male Referee of the Year for extraordinary accomplishments as a young soccer referee if the individual:

(1) was certified as a USSF referee in both 2020 and 2021 seasonal years;

(2) during those two seasonal years, refereed games primarily for US Youth Soccer, the Metro DC/Virginia State Referee Program, or VYSA sanctioned tournaments; and,

(3) did not reach 19 years of age prior to August 1, 2020.

Nominees are expected to participate in State Cup semi-final games on October 31, 2021 and State Cup final games on November 7, 2021. Selectees are expected to be available to participate in state and regional events in May, June, and July 2022.

Please direct questions to the State Youth Referee Administrator, AG Gomez, at agsyradcv@gmail.com.

Your Name*

First NameLast Name

Your E-Mail Address*

If submitting on behalf of an organization, what is the organization name?

Your Address*

Street Address

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Your Phone Number*

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Your role in relation to the nominee*

Nominee's Name*

First NameLast Name

Young Female Referee of the YearYoung Male Referee of the Year

Nominee's Home Address*

Street Address

Street Address Line 2

CityState

Zip Code

Nominee's Email Address*

Nominee's Parent's Email Address*

Nominee's Phone Number*

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Parent's Phone Number*

Date of Birth

USSF ID

0000-0000-0000-0000

Grassroots RefereeRegional Referee

Selection Criteria: Reponses to each of the following three criterions should be kept to a maximum of 500 words.

1) Personal development: How and when did the nominated referee get involved with soccer? How has the referee’s involvement with soccer shaped his/her character? Does the referee display moral and ethical behavior on and off the field? What steps has the nominee taken to improve upon his or referee knowledge of the game?

0/500

2) Promoting the game: What steps has the referee taken to further advance the game and all who participate? Does the referee participate in soccer outside his or her position as a referee (i.e. player, coach, or volunteer)? Has the referee created relationships within the community to promote the game? Be specific.

0/500

3) Involvement in Community: Has the referee demonstrated leadership within the community? Give examples. What other activities, aside from soccer, is the referee involved in? What impact has his or her involvement had on the community?

0/500

Letters of Recommendation. A minimum of three letters of recommendation are required; five are recommended. If selected as the State Youth Referee of the Year, three of these letters will be forwarded to the regional selection committee.

Letter of Recommendation (Upload at least 3 files)

Accomplishments. Please upload a list of the nominee's officiating events for at least the past two years. Include dates, event names, locations, and positions. If mentored or assessed, include the names of the mentors or assessors. Comments about the events are welcome.

Accomplishments