Application to become Regional, National, Category 2, and Category 1

USA Powerlifting Referee Requirements and Procedures (Effective July 15, 2023)

Name*

First NameLast Name

State*

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

Email*

Confirmation EmailConfirm email address

State Chair's name*

Has your state chair given approval for you to apply for promotion to the next referee rank?*

YesNo

For which level of test are you applying?*

RegionalNationalCategory 2Category 1

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

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

Date (month and year) that the rank of category 2 referee was obtained*

Have you completed SafeSport training / Is your SafeSport training current?*

YesNo

Please indicate that you have had experience and are proficient with all of the following: equipment check (both raw and equipped), weigh-in, score table, and drug testing.

Yes, I have experience and I am proficient in each of these areas.

Has your background check been completed?*

YesNo

Have you gone through drug testing training?*

YesNo

In order to be eligible for the regional referee rank, candidates must have been a referee for an entire session at 6 different full power events. Please list those 6 events and your referee position for each below. Regional referee candidates will not be selecting "Jury" for the position of any of the events listed.

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. National referee candidates will not be selecting "Jury" for the position of any of the events listed.

In order to sit for the category 2 exam, candidates must have been a referee for an entire session in at least 4 different full power national and/or pro events (must have been chief referee at 2 of those events) within the most recent 4-year period. Please list those 4 events and your referee position for each below.

In order to sit for the category 1 exam, candidates must have been a chief referee or jury member for an entire session in at least 4 different full power national and/or pro events within the most recent 4-year period. Please list those 4 events and your referee position for each below. Category 1 referee candidates will not be selecting "Side Referee" for the position of any events listed.

Event #1: Year and event name*

Event #1: Served in the following position for the full session*