OHIO-NORTH STATE REFEREE COMMITTEE
Referee request for upgrade (To 7A or 6)
Submission of this form to the SRA, initiates the process for a Referee to be considered for an upgrade to grade
7A or 6. The initial declaration should include the top two sections completed (Referee Information and Game
Experience). Upon review by the SRA, confirmation shall be provided to proceed and complete the upgrade
requirements. The Referee must register, as appropriate, and complete all requirements, tracking completion
as per below. When all requirements have been completed, the Referee should submit the completed form to
the SRA for review and confirmation by all SRC administrators. The SRA will notify the Referee of status and
any fees.
Name:
Address:
USSF ID#:
Date Became Referee:
Upgrade From Grade:
REFEREE INFORMATION
Birth Date:
City:
Phone:
Date Attained Current Grade:
To Grade:
GAME EXPERIENCE (game count)
Referee
AR
Youth (U17 or higher)
Adult (not including co-ed)
Total
CLINIC TRAINING
Location:
Date:
Grade 7A Requirement:
Adult Referee Course or Intermediate Course
Grade 6 Requirement:
State Referee Course
EXAM
Location:
Date:
Grade 7A Requirement:
Adult Referee exam
Grade 6 Requirement:
State Referee exam
FIELD EVALUATIONS
Position/Game Level:
Position/Game Level:
Position/Game Level:
Date:
Date:
Date:
Grade 7A Requirement:
1 passing assessment as a referee on a U-17 or
higher level match
Grade 6 Requirement:
2 passing assessments as a referee on U-17 or higher
(one of which must be an adult match)
1 passing assessment as an AR
FITNESS TEST
Location:
Grade 7A Requirement:
Pass USSF PPT as determined by SRC
Revised: 12/13/16
Date:
Grade 6 Requirement:
Pass USSF PPT as determined by SRC
The Ohio-North SRA shall review the application and notify the referee of status and fees.
1.
2.
3.
4.
5.
It is the referee’s responsibility to complete the form and complete requirements.
SRC administrators will review applicable requirements and confirm with the SRA.
The requirements may be met in any order.
Primary record of attendance / completion of requirements will be proper registration within Game Officials.
SRA may request a separate attachment (spreadsheet) of game records.
Revised: 12/13/16