Referee Application - 2012 Grove United Memorial Day Shootout

May 25-28, 2012 | Schaumburg Olympic Park

All referees must fill out the following form to be considering for match assignments at the 2012 Memorial Day Shootout Soccer Tournament, presented by Grove United. All referees must be current on their USSF certification (2012) and have an IYSA background check on file (background check only applicable to referees 18 years of age or older).

Referees under the age of 16 must apply for and submit a work permit received from their school. Click here to print our overview letter. Please mail the yellow copy of the work permit to our P.O. box below.

If you have any questions, please e-mail the Tournament Referee Assignor, Vijay Kumar <groveunited@vjkumar.org>. Vijay or his staff will respond to all inquiries promptly.

Please note, this is a highly competitive tournament and not all referees will be accepted.

Application Deadline: April 22, 2012

Full Name
First and last name
E-mail Address
Full Mailing Address (including City/State/Zip)
Must be accurate - your check will be sent here!
Phone (cell)
Okay to send SMS (text) messages?
Phone (home)
Phone (work/other)
Availability - Friday, May 25



Availability - Saturday, May 26






Availability - Sunday, May 27






Availability - Monday, May 28



Conflicts
Please provide any details if you are a player, coach, parent, or have any other conflict of interest with any team enrolled in this tournament. Refer to the Referee Administrative Handbook for any questions on the Federation's "conflict of interest" policy.
USSF Grade
Most new referees are Grade 8. This is not your school grade.
Assignments Desired



Experience
Please provide as much detail as possible regarding your experience as a referee. Include all relevant certifications, number of years of experience, typical match assignments, other assignor references, etc. Minimum of three (3) years experience as a referee.
Highest Comfort Level (Referee)






Highest Comfort Level (Assistant Referee)




Comments
   

Upon acceptance of your application, all referees will be required to fill out IRS Form W-9 and an IYSA Medical Release Form. These documents must be submitted via e-mail or postal mail prior to the tournament. More information will be available on the next page after submitting your application.

Referees under the age of 16 must submit a work permit. This can be obtained from your school with our overview letter.

E-mail address for document submissions (must be signed and scanned): <groveunited@vjkumar.org>

Mailing address for document submissions:
Vijay Kumar
Attention: Grove United 2012
P.O. Box 268
Libertyville, IL 60048