Self-Assessment Form
Submitted by
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First Name
Last Name
Email
*
example@example.com
Development Program
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Please Select
NPL
State League
Academy Advanced
Academy Developing
Academy Emerging
Community
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Match Details
Competition Type
*
Australian Cup (Preliminary Rounds)
Dockerty Cup
Nike Cup
Regular Season Match
League
*
Please Select
NPLM
VPL1
VPL2
NPLW
NPLM 23s
VPL1 23s
VPL2 23s
NPLW 20s
MSL1
MSL2
MSL3
MSL4
MSL5
VPLW
WSL1
WSL2
WSL3
WSL4
WSL5
SL Reserves
Other
Other
Please provide league and age group
Role
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Please Select
Referee
Assistant Referee 1
Assistant Referee 2
Date
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-
Day
-
Month
Year
Date
Hour Minutes
AM
PM
AM/PM Option
Round
*
Please Select
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
Finals
Venue
*
Home Team
*
Away Team
*
Is there video footage available?
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Please Select
Yes
No
Please provide the link
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Disciplinary Control / Foul Recognition
Please include any incidents in the match that are listed from the dropdown options below.
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Penalty Area Incidents
Please include any incidents in the match that are listed from the dropdown options below.
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Game Management
Please highlight any moments in the match that are listed from the dropdown options below.
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Match Control
Please highlight any moments in the match that are listed from the dropdown options below.
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Offside Judgement / Interpretation
Please highlight any offside decisions that are decisive or lead to goal scoring situations.
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Additional Comments
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