ESR Referee Academy Application

Click Here: Personal Information
Referee Training & Certification Coures: Information will be provided by our referee assignors to notify you of upcoming training and certification courses.

UPCOMING GRASSROOTS COURSES
Full Name*

First NameLast Name
Birth Date*

MonthDayYear
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Phone Number*

Area CodePhone Number
Cell Number

Area CodePhone Number
Email*
Alt Email
Describe Me Best As...
Community Clubs / Locations You Can Work

WSA Central (Tulsa & Sand Springs)WSA OKC (SNU & SW Christian)WSA North (Claremore)WSA South (Ft Gibson, Tahlequah, Muskogee)WSA OC (Skiatook)WSA East (Tulsa)
What State Do You Live In?
What City Do You Live In?

Click Here: Certification Level
Certification Level: Check The appropriate level of certification
Certification Level: Check The appropriate level of certification*

8 black badge9 blue badgeNOT Certified
Please check here if you have previously officiated travel games.*

Yes I haveNo I have Not

Click Here: Availability
Please take into account the following when filling in times you're available to referee. ALL commitments for school, academic, band, sport, club, church,work or family activities. This is a GENERAL schedule of availability. Once certified the referee assignor will communicate with you on a monthly basis for availability. Only referees that have submitted this form will be scheduled for games.

WEEKNIGHTS

WEEKENDS

	8 AM	9 AM	10 AM	11 AM	12 PM	1 PM	2 PM	3 PM	4 PM
SATURDAYS
SUNDAYS

Any Weekends the Next 6 Months you are certain you are NOT available:
Any Other Schedule Parameters the Assignor Should Know About:
Tell us your next steps and which, if any, or if all, apply to you:

Yes Please Contact me about refereeing in your clubYes I want to learn how to become certifiedYes I want to join ESR Academy and Enjoy the BenefitsI am an experienced referee and want to referee high profile tournaments & eventsI am not certified but ready to learn and get "reffed up"!