Referee Questionnaire

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Thank you for your interest in working as a referee for Soccer in the Streets. This questionnaire will determine the best placement for you. Recommended minimum age is 13.

Once you complete this survey, you will be contacted to provide further information required to receive timely payments (tax form, info for direct deposit or check) Payments will be made monthly. THERE WILL BE NO CASH PAYMENTS. Payment information will be required before being scheduled for matches. Scheduling will take place on a week by week basis, through email and/or your preferred communication.

Additional support available for teens and young adults:
* Financial literacy classes
* Advanced referee training and mentoring
* Referrals for additional game assignments
* Uniform & equipment assistance
* Certification/recertification course information

NOTE TO PARENTS: If you are submitting this information on behalf of your child, please include your name. If you need to submit for more than one child, you will need to submit a response for each child.

If you need further assistance, please contact Kerri Worthen, kerri@soccerstreets.org for more information.

Email *

Record my email address with my response

FIRST NAME *

LAST NAME *

Date of Birth (include actual year you were born) *

YYYY

If under 18 years of age, please complete parent/guardian information:

Parent/Guardian First & Last Name:

Parent/Guardian Email:

PHONE NUMBER *

Preferred method of communication for assigning games: *

PHONE/TEXT

PLAYMETRICS

Required

Do you currently play on a Soccer in the Streets team? *

If so, which team? (Include age group/location)

Below are questions about your experience and availability:

What is your level of referee certification & experience? *

No certification, no training, no experience

No certification, some training, no experience

No certification, some training, some experience

USSF Grassroots, no experience

USSF Grassroots, some experience

USSF Grassroots, one or more years of experience

USSF Grassroots, very experienced

What Station Soccer location would you prefer to be assigned? *

Lindbergh Station

West End Station/Adair Park

East Point Station

Kensington Station

Eastlake Station

Other:

Required

What are your preferred DAYS/TIMES? *

8 AM - 12 PM

12 PM - 3 PM

3 PM - 5 PM

NONE

SATURDAY

SUNDAY

Any other considerations regarding schedule? (Transportation, experience, physical limitations, relationships with other teams/clubs, etc.)

Send me a copy of my responses.

Submit

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