Referee Assessment / Evaluation Request
Assessments must be requested no less than two weeks prior to the match with all necessary paperwork including game records.
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Email *
Date of Match: *
MM
/
DD
/
YYYY
Referee's Complete Name *
Referee's Cell Number *
Type of Field Evaluation *
Game Type *
For Upgrade Requests-Submitted my game count to: ISRC, SRA *
Required
Referee's Current Level *
Upgrading: *
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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