Referee Questionnaire | Game Day Checklist(39 Characters)

First Name

Last Name

Do you consider yourself a(n)

Youth Referee
Adult Referee

Please list your home city and state (Example: Albuquerque, NM)

Referee Level

Email (Must be the same for Assignr)

Email

Confirm Email

Cell Phone Number

Parent's Name

First

Last

Email of Parent or Adult if Under 18

Parent Cell Phone Number

Year of Birth

Are you a new official

YES
NO

The approximate year you first started officiating

The Highest Level You feel Comfortable Officiating

What's the highest level you were a Center last season for Duke City

What's the highest level you were a AR last season for Duke City

What's The highest Level of competition you have officiated?

Your Assignment Preference

AR Only
Center Only
Both

Do you also officiate high school games

YES
NO

Have you taken an in-person class?

I took the 8-hour in-person class
I took the 16-hour class or longer prior to COVID
I attended a workshop in which I completed the class online with help
I have only completed the online training
Other or I do not know

Have you gone through a mentor game and been evaluated

Yes, an AR Mentor Game through Duke City
Yes, a Center Mentor Game through Duke City
Yes, I have been mentored from another league or tourney
No, I have never gone through a mentor game

Please describe your playing expereince

How many years have you played?

Please list any additional training or experience you would like to be considered when assignments are being made

This season Duke City has formed a partnership with AYSO Region 104 in which it will assign USSF certified referees to center recreational U13/U14 matches at Manzano Mesa Park . The games are designed to help devlop newer referees in a less competititve enviroment. The pay will be the same. Are you interested in officiating any of these matches?

Yes
No
I am unsure

Badge Issued

Special Requests

Please indicate if you want to Center, AR and which age groups you would like to officiate or not officiate. Also please list any schedule conflicts. If you have no preferences type n/a

National League Games - This season DCSL will be assisting in assigning games for the four national leagues that play in Albuqurquerque - Girls Academy, Elite Clubs National League, Elite Academy and Development Player League. Please indicate if you would like to be considered for officiating these games. You must have four years of experience.

I would like to be considered
I do not want to be considered
I am unsure at this time

Head Shot (Used to help assignor assign games)

Drag & Drop Files, Choose Files to Upload

This helps the assignor to get to know the referee

Assignor's Access

Click for Admin Access (Assignor's Only)

Password

USSF ID

https://learning.ussoccer.com/directory

Certification

Assignor's Notes

Date / Time

Paragraph Text

Game Log

Turnbacks

Date

Game Number

Reason

Assignor

Video

Date

League

Position

Website / URL

Evaluations

Date

League

Type

Link to Document

Approved Levels

Notifications

Do Not Send Email
Send Video Email
Send Evaluation Email

DCSL Approved

Referee – Questionnaire

Assignor's Notes

Turnbacks

Video

Evaluations