Request for Referee Assessment

Request for Referee Assessment
For an assessment 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 assessor assignor)
3. You will be contacted once an assessor has been assigned to you.
  Important Note: Please make sure your entire referee team for that game is currently 2022 approved.
Assessment Fee Schedule
Assessment by Mentor - $50
Assessment by Regional Assessor - $125
Assessment by National Assessor - $150

For additional assessment questions, please contact Rick Rehm at rrehm@calsouth.com.
Assessment Date *

Year Month Day
Date
Game Time *

: Hour Minutes AM/PM Option
Upgrade *
Present Level *
Type of Assessment *
Referee Name *

First Name Last Name
Referee Email *
example@example.com
Phone Number *

Area Code Phone Number
Assignor Name *

First Name Last Name
Field Name *
Field Number *
Field Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Additional Information
Should be Empty: