Team Vic Student Officials Application Form

Student's Full Name

First NameLast Name
Email
example@example.com
Date of Birth

DayMonthYear
Date
Gender

MaleFemalePrefer not to say
Parent Guardian Full Name

First NameLast Name
Email
example@example.com
Mobile Number
Please enter a valid phone number.
School Name
Year Level*
Does your child have any medical conditions?

NoYes
Does your child have any dietary requirements?

NoYes
Choose the sport
Australian Football - Official Type*

Field UmpireGoal UmpireBoundary Umpire
Which SSA Championships are you applying to attend?

12 Yrs - 03 to 10 Aug in Maroochydore, QLD15 Yrs - 26 Jul – 02 Aug in Moreton Bay, QLD
Baseball - Official Type*

Plate UmpireBase UmpireOutfield Umpire
Which SSA Championships are you applying to attend?

18 Yrs - 27 Apr to 03 May in Perth, WA
Basketball - Official Type*

RefereeBench Official
Which SSA Championships are you applying to attend?

12 Yrs - 26 Jul to 01 Aug in Moreton Bay, QLD16 Yrs - 26 Jul to 01 Aug in Moreton Bay, QLD
Football (Soccer) - Official Type*

RefereeAssistant Referee
Which SSA Championships are you applying to attend?

12 Yrs - 25 to 30 Oct in Ballarat, VIC18 Yrs - 26 Jul to 01 Aug in Moreton Bay, QLD
Hockey - Official Type*

Umpire
Which SSA Championships are you applying to attend?

12 Yrs - 17 to 22 Aug in Bendigo, VIC15 Yrs - 02 to 09 Aug in Canberra, ACT
Netball - Official Type*

UmpireBench Official
Which SSA Championships are you applying to attend?

Netty 12 Yrs - 25 to 30 Oct in Ballarat, VIC15 Yrs - 26 Jul to 01 Aug in Moreton Bay, QLD
Rugby League - Official Type*

Referee
Which SSA Championships are you applying to attend?

11-12 Yrs - 26 Jul to 01 Aug in Moreton Bay, QLD
Softball - Official Type*

Plate UmpireBase UmpireOutfield Umpire
Which SSA Championships are you applying to attend?

12 Yrs - 25 to 30 Oct in Ballarat, VIC15 Yrs - 24 to 30 May in Eastern Creek, NSW
Touch Football - Official Type*

Referee
Which SSA Championships are you applying to attend?

12 Yrs - 25 to 30 Oct in Ballarat, VIC15 Yrs - 25 to 30 Oct in Ballarat, VIC
Volleyball - Official Type*

First RefereeSecond RefereeLine Judge
Which SSA Championships are you applying to attend?

15 Yrs - 15 to 20 Jun in Adelaide, SA
Highest level officiated at?*
Please upload umpire accreditation (if applicable)

Cancelof
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