Ayso Application For Referee Certification Form
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1
2AYSO Application for Referee Certification
PLEASE RETAIN A COPY OF THIS FORM AS YOUR RECORD OF COMPLETED TRAINING (needed for Upgrade)
Thank you for volunteering your time as an AYSO referee. The AYSO National Referee Program provides training to enable
volunteers to officate an AYSO soccer match under FIFA Laws of the Game and the AYSO National Rules and Regulations.
Training in AYSO is a continual process. Referees are encouraged to take additional courses and attend other training
regardless of whether or not they intend to upgrade.
Regional Referees - Retain a copy for your files.
There is no need to send to the National Office.
Name:________________________________________ Phone:_______________ Section____ Area ____ Region__________
Address:________________________________________ City:______________________ State________ Zip_____________
Date of Birth
AYSO ID (from eAYSO):_______________________________________________
(if under 18)____________
Roster #
Authorizing Printed Name, Title, Signature
Date
Safe Haven (required for all levels of certification)
Mod. 1: Safe Haven Certification (or verification)
Lead
Regional Referee, Assistant Referee, or U8 Official
Basic Referee
Assistant Referee
U8 Official
U8 to AR
AR to Basic
CANDIDATE COMPLETED ENTIRE COURSE:
U8 to Basic
Basic Referee Online Course (verification) + Basic Referee Companion Course (classroom)
Roster #
Lead
OR, CANDIDATE COMPLETED THE FOLLOWING MODULES:
Mod. 2: The Game of Soccer
Lead
Mod. 3 & 11: Understanding Younger Players
Lead
Mod. 4: Pre-game and Post-game Duties
Lead
Mod. 5: Starting the Game
Lead
Mod. 6: Stopping the Game
Lead
Mod. 7 & 12: Restarting the Game
Lead
Mod. 8: Fouls and Misconduct - Basic
Lead
Mod. 9: Offside - Basic
Lead
Mod. 10: Ref and Assistant Ref Mechanics
Lead
Mod. 13: Fundamental Coaching Concepts
Lead
Basic Referee (minimum score 75%)
Assistant Referee
U8 Official
WRITTEN EXAMINATION:
Tester
Regional Referee
Assistant Referee
U8 Official
I have completed all requirements for certification as:
MODULES REQUIRED FOR CERTIFICATION:
U-8 Official: Modules 1 - 7
Assistant Referee: Modules 1 - 7, 9, 10, 11, 12
Regional Referee: Modules 1 - 13
Applicant's Signature
Date
Regional Referee
Assistant Referee
U8 Official
The above referee has completed all requirements for certification as:
Regional Referee Administrator's printed name
Regional Referee Administrator's signature
Date
August 2014
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