Application to Officiate

Name:     Club:     LSC:

E-Mail:     Phone No:

Current Certifications and Level (check all that apply):

Referee N1--LSC N2--Nat'l N3--Nat'l Champ    Starter N1--LSC N2--Nat'l N3--Nat'l Champ    Stroke&Turn N1--LSC N2--Nat'l N3--Nat'l Champ   
Hy-Tek     Colorado

Sessions (check all that apply):

Course Preference for Preliminaries:

Comments (include specific assignment requests here):
   

We have applied to have this meet designated as a "qualifying meet" under the new national officials' certification program. Any official interested in being evaluated (N2 evaluations only) must apply in advance. Send the "Request for Evaluation" form (PDF or DOC) to the PVS Officials Chair. Details of the certification program can be found on the Certification Page of the USA swimming website.

You must apply no later than February 23th for specific deck positions. However, late applications to officiate at this meet and walk-ins are also welcome and will be assigned to available positions.

Any questions or comments about this form can be directed to thusson@comcast.net.