Application to Officiate

Potomac Valley Senior Championships
George Mason University, Fairfax, VA
March 11-14, 2010

You may use this form to apply to officiate the Potomac Valley Short Course Championship meet. You may also email your request to the PVS Officials Chair.

This meet has been designated by USA Swimming as a "qualifying meet" under the national officials' certification program. Any official interested in being evaluated (N3 S&T, N2 all other positions) must apply in advance. Send the "Request for Evaluation" form (PDF or DOC) to the PVS Officials Chair. Also indicate your evaluation request on the form below. Details of the certification program can be found on the Certification Page of the USA Swimming website.

Name:     Club:     LSC:

E-Mail:     Phone No:

Current Certifications and Level (check all that apply):

   Referee    Starter    Stroke&Turn   

    Hy-Tek     Colorado

Sessions I will work (check all that apply):

Thursday Distance Friday Prelims Friday Finals
Saturday Prelims Saturday Finals Sunday Prelims Sunday Finals

Course Preference for Preliminaries:

Girls Course Boys Course No Preference


I request to be evaluated at:      

Comments (include specific assignment requests here):

You must apply no later than February 23rd 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.