Contact Information

First Name

Last Name

Email Address

Please confirm your Email Address

Your Age

Phone Number (XXX-XXX-XXXX)

USSF Grade: [Entry level referees are Grade 8]
Select your grade Emeritus 8 7 6 5 4 3

Availability & Experience

Please choose the date you are available to work games
Select availble dates Sept 11 Sept 18 Sept 25 Oct 2 Oct 9 Oct 16

Check all the times you CAN work games:

All Day
8 am
9:30 am
11 am
12:30 pm
2 pm
3 pm
4 pm

Maximum number of games preferred per day:
Select 2 3 4 5 or more

How long have you been a soccer referee?
Select This is my first year 1 year 2 years 3 years 4 or more years

Highest comfort level as REFEREE for BOYS:
Select I do not feel comfortable as a referee. U-12 and below U-14 U-16 U-18 Adult Men

Highest comfort level as REFEREE for GIRLS:
Select I do not feel comfortable as a referee. U-12 and below U-14 U-16 U-18 Adult Women

Highest comfort level as ASSISTANT REFEREE for BOYS:
Select U-12 and below U-14 U-16 U-18 Adult Men

Highest comfort level as ASSISTANT REFEREE for GIRLS:
Select U-12 and below U-14 U-16 U-18 Adult Women

Conflicts

Are you playing in this league?
Please select Yes No

What team do you play for?

What time(s) do you play?

Are you coaching, kids playing, or affiliated with any team in this league?
Please select Yes No

What team are you affiliated with?

What time(s) does your team play?

Other Information

What other information does the Assignor need to know?