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2018 LSA Referee of the Year - Nomination Form - Fall 2018
Requirements to apply:
An individual may be nominated and selected as the Young Female Referee of the Year or the Young Male Referee of the Year for extraordinary accomplishments as a young soccer referee if the individual—
(1) was certified as a Federation referee during the seasonal year immediately prior to the seasonal year for which the individual is being nominated;
(2) is certified or being certified as a Federation referee during the seasonal year for which the individual is being nominated;
(3) during those two seasonal years, refereed games primarily for US Youth Soccer, a region, a State Association, or a member or team of any of those organizations; and
(4) did not reach 19 years of age prior to that August 1 immediately before the beginning of the seasonal year for which the individual is being nominated
State Home Association: *
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Select only one category: *
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NOMINEE Name: (Type name EXACTLY as it should appear on a certificate) *
Your answer
NOMINEE Address: (City State and zip) If unknown please type in unknown *
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NOMINEE Phone Number: *
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NOMINEE Email address: (If unknown please type in unknown) *
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NOMINEE Date of Birth: (If unknown please type in unknown) *
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NOMINEE Referee Grade: (If unknown please type in unknown) *
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NOMINEE USSF ID #: (If unknown please type in unknown) *
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CRITERIA: Responses to each of the following questions/statements must be kept to a maximum of 400 words per criterion! Please check that you agree to keep responses to 400 words or less: *
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1) Personal development:How and when did the nominated referee get involved with soccer? How has the referee’s involvement with soccer shaped his/her character? Does the referee display moral and ethical behavior on and off the field? What steps has the nominee taken to improve upon his or referee knowledge of the game? *
Your answer
2) Promoting the game:What steps has the referee taken to further advance the game and all who participate? Does the referee participate in soccer outside his or her position as a referee (i.e. player, coach, or volunteer)? Has the referee created relationships within the community to promote the game? Be specific. *
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3) Involvement in Community:Has the referee demonstrated leadership within the community? Give examples. What other activities, aside from soccer, is the referee involved in? What impact has his or her involvement had on the community? *
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NOMINATOR Name: *
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NOMINATOR Relationship to Nominee: *
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NOMINATOR Phone Number: *
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NOMINATOR Address: (City, State and Zip) *
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NOMINATOR Email Address: *
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NOMINATOR Email Address: *
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