Wisconsin Soccer Referee Development Program


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Request for Assessment

Complete this form and click the submit button to send your request for assessment to the State Director of Assessment. You will receive an email confirmation of your request which will include the address to mail your check payable to WISREF (you are required to pay the equivalent of your game fee for the assessment).

* = Required      
       
USSF 16-digit ID: Current Level: *
First Name: * Last Name: *
Address: City, St, Zip:
Home Phone: Cell Phone:
Email Address: *
Type: *
Position: *
Comments:
   
Games Available for Assessment
Game #1
Arbiter Game #: Arbiter Group #:
Date: Click Here to Pick up the date * mm/dd/yyyy Time: : *
Level: * Site: *
Home Team: Visiting Team:
Other Officials
(if known):
       
Game #2
Arbiter Game #: Arbiter Group #:
Date: Click Here to Pick up the date mm/dd/yyyy Time: :
Level: Site:
Home Team: Visiting Team:
Other Officials
(if known):
       
Game #3
Arbiter Game #: Arbiter Group #:
Date: Click Here to Pick up the date mm/dd/yyyy Time: :
Level: Site:
Home Team: Visiting Team:
Other Officials
(if known):
       

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