Assessment Request Form
Use this form to request an assessment.

INSTRUCTIONS:

1) You MUST have a game already assigned to you BEFORE you complete this form. Work with your appropriate league scheduler to get a match that meets the assessment criteria, then request an assessment through this form.
2) The more advanced notice you provide, the more likely you are to get an assessment. Assessors are in high demand and are very busy. Please try to give 7 days notice for an Assessor to be assigned.
3) Enter correct information on the form below. Information on this form is critical ensuring you get the right type of Assessor and assessment.

Once you submit the assessment request form, you will receive an automatic confirmation we have received it. The process to locate an Assessor will begin within 24 hours of request. The SDA will contact you by email or phone a few days later to confirm the status of your request.

If you do not hear back within 3-4 days, please contact the SDA for additional information.

Referee Information
Email *
What is the referee's email address?
Your answer
First Name *
What is the referee's first name?
Your answer
Last Name *
What is the referee's last name?
Your answer
Address *
What is the referee's street address?
Your answer
City *
What is the referee's street city?
Your answer
State *
What is the referee's state?
Your answer
Zip *
What is the referee's zip code?
Your answer
Phone *
What is the referee's phone number on game day?
Your answer
Grade Level *
What is the referee's current USSF grade level?
Game Information
Please be sure you have reviewed the game requirements at www.kansasreferee.org under the "Assessment" tab.
Game Date *
When does the game begin?
MM
/
DD
/
YYYY
Time
:
Game City *
What is the city where the game will be played?
Your answer
Game Location *
What is the location of the game (ie: Overland Park Soccer Complex, Styrker, etc)?
Your answer
Field Number
What is the field number of the game? If there is only one field, leave this blank. It is OK to tell the assessor this later if you do not know yet.
Your answer
Assessment Type *
What type of assessment do you want?
Required
Before You Submit
Once you submit the assessment request form, you will receive an automatic confirmation we have received it. The process to locate an Assessor will begin within 24 hours of request. The SDA will contact you by email or phone a few days later to confirm the status of your request.

If you do not hear back within 3-4 days, please contact the SDA for additional information.

Once an assessor is assigned, please notify your assignor and let them know you have a confirmed assessor. That way, they do not not change your game.

At times, assessors may not be available. In that case, we will request you find a different game to be assessed.

Remember to click "Submit" below when you are ready. Best wishes for success and growth!

Bronson Broockerd, SDA

Submit
Never submit passwords through Google Forms.
This form was created inside of Kansas Soccer Association. Report Abuse - Terms of Service - Additional Terms