Format - Legal Name (Preferred Name if applicable) for reporting in OTS

Format xxx-xxx-xxxx

Home Address - Street

Please use club code with which you are associated

Please only mark highest level of certification for each position

If you wish to be considered for an assignment, please indicate first choice.  Those serving all sessions or requesting evaluations will be given first priority

If you wish to be considered for an assignment, please indicate first choice.  Those serving all sessions or requesting evaluations will be given first priority

REQUEST FOR EVALUATION

This meet has been approved as an N2 or N3 qualifying meet.  If you wish to be evaluated, please indicate the position for which you wish to be evaluated.  Only one evaluation will be completed at the meet with requisite sessions.  You must work a minimum of four (4) sessions.  For N3 Stroke and Turn, mark N3 Initial.  Please make sure you have completed all required elements prior to requesting an evaluation.  Please check the USA Swimming website for more information: (https://www.usaswimming.org/officials/national-certification-evaluation). 

Please list your previous evaluator in the area for which you are requesting an evaluation and the meet at which the evaluation was completed and restate the positions for which you are requesting the evaluation (i.e., CJ, SR, DR, AR, AO).

For host planning purposes ONLY.  There is no guarantee that shirts will be given out.  If shirts are provided, you must work a minimum of four (4) sessions to receive a shirt.