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2022 Judge Check Request Form
Judge Pay Rate is $35 per hour. Mileage is $0.50 per mile.
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Region
Your answer
Name of Region Chair
Your answer
Date of Evaluations
MM
/
DD
/
YYYY
Name
Your answer
Phone Number
Your answer
Email
Your answer
Mailing Address
(include City, State, Zip)
Your answer
Start of Judging Time
Time
:
AM
PM
End of Judging Time
Time
:
AM
PM
Total Judging Time
Your answer
Amount Due for Judging Time
(Total Time X $35)
Your answer
Total Mileage
(2-way total miles)
Your answer
Amount Due for Mileage
(Miles X $0.50)
Your answer
Total Amount Due
(From above: Judge amount due + Mileage amount)
Your answer
Do you have any comments or suggestions after your experience judging Performance Evaluations? Please include them below.
Your answer
I certify that to the best of my knowledge and belief all answers listed above are true and accurate. I understand that by typing my name in the box below I am signing this document as though it were a physical document.
Your answer
Date of Signature
MM
/
DD
/
YYYY
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