Request for Referee Evaluation

Request for Referee Evaluation
For an evaluation request please complete the following immediately (same day you receive your assignment)
1. Fill out request form below. (Please review information for accuracy) NOTE: You may add comments in the last box.
2. Press the "Submit Request" button below. (Form goes directly to the Referee Coach assignor)
3. You will be contacted once an Referee Coach / Mentor has been assigned to you.
  Important Note: Please make sure your entire referee team for that game is currently on the ROL.
Evaluation Fee Schedule
- Evaluation by Referee Coach - $150
- Evaluation by National Referee Coach - $200
For additional questions contact rrehm@calsouth.com.
Evaluation Date

YearMonthDay
4 digit year, 2 digit month, 2 digit dayDate
Game Time

:HourMinutesAM/PM Option
Upgrade?
Game level?
Present License Level
Type of Evaluation
Referee Name

First NameLast Name
Referee Email
example@example.com
Phone Number

Area CodePhone Number
Assignor Name

First NameLast Name
Field Location Name
Field Number
Field Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Additional Information
Registered Official List (ROL) Review

IMPORTANT: The evaluation report will not be able to be completed by the Referee Coach in RefEval unless all referees in your crew are approved to be on the field. Please agree that you have already confirmed that the other referees in your crew are listed on the ROL here.
I agree and have checked to make sure all referees on my crew are approved.
Should be Empty: