Referee Assessment / Evaluation Request

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Assessments must be requested no less than two weeks prior to the match with all necessary paperwork including game records.

Email *

Date of Match: *

YYYY

Referee's Complete Name *

Referee's Cell Number *

Type of Field Evaluation *

Maintenance Evaluation

Upgrade Evaluation

Developmental

Game Type *

For Upgrade Requests-Submitted my game count to: ISRC, SRA *

Yes

Required

Referee's Current Level *

Grassroots

Regional

National

Upgrading: *

Grassroots to Regional

Maintaining Regional

Regional minimum 2 years at level, like to be considered by USSF as a National Official.

League Name: *

Match Kickoff *

Time

Game Location / Address *

Home Team *

AWAY TEAM *

REMINDERS

I understand that I must follow the protocol and I MAY NOT contact the Assessor/Referee Coach to conduct the assessment. If I fail to follow the established protocol, I understand that there will be disciplinary actions taken against me and up to, but not limited to, suspension, downgrade, and potentially losing my license. The assessment fee must be paid to Illinois State Referee Committee (ISRC), on submission of the assessment request. PAYMENTS are not made to the assessors directly.

$65 - Referee Developmental Program
$75 - Upgrade Grassroots to Regional and Regional Maintenance
$100 - Regional with National coach Involvement for Assessment

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