Ayso Referee Attendance Roster Form

ADVERTISEMENT

AYSO Referee Attendance Roster
Course Number: ____________________
Roster Number: ___________________
Page ______ of _______
Section/Area/Region: _________________
Lead Instructor: ___________________
Course ID: ___________
Contact Person: _____________________
Lead Instr. Phone: _________________
Training Date: ________
Contact Person Phone: _______________
Co-instructor: _____________________
Total Attendees: ______
Contact Person email: ________________
Co-instr. Phone: ___________________
Date Received: _______
Instructor Note: Stress the importance of attendees retaining their own training records. Have extra copies of the AYSO
Application for Referee Certification form on hand in case they are needed. For modular training sessions done over an
extended period of time, you may delay submitting the roster until the last session is finished. When all training is
completed, return the original roster to the National Office and retain a copy for your records. Please cross out the names of
those who either did not complete or should not be credited for the training. Discard the tests after review. Return completed
or canceled course rosters to: AYSO, 19750 S Vermont Ave., Ste. 200, Torrance, CA 90250. Phone (800) USA AYSO.
Rosters, including canceled courses, may also be returned by e-mail () or by fax (310-525-1155).
ROSTERS MUST BE RETURNED TO THE National Office FOR ATTENDEES TO RECEIVE CREDIT FOR THE TRAINING.
Name: _____________________________
Check Basic Module(s) Completed:
Check if Complete Course:
Address: ___________________________
1___ 2___ 3___ 4 ___ 5___ 6___ 7___
U-8 Official Course: ____
City: _______________________________
8___ 9___ 10___ 11___ 12___ 13___
Asst. Ref. Course: _____
State, Zip: __________________________
Check Intermediate Module(s) Completed:
Basic Course: ________
Section/Area/Region: _________________
14___ 15___ 16___ 17___ 18___ 19___
Intermediate Course: ___
Telephone: _________________________
Check Advanced Module(s) Completed:
Advanced Course: _____
e-mail: _____________________________
20___ 21___ 22___ 23___ 24___
National Course: ______
Name: _____________________________
Check Basic Module(s) Completed:
Check if Complete Course:
Address: ___________________________
1___ 2___ 3___ 4 ___ 5___ 6___ 7___
U-8 Official Course: ____
City: _______________________________
8___ 9___ 10___ 11___ 12___ 13___
Asst. Ref. Course: _____
State, Zip: __________________________
Check Intermediate Module(s) Completed:
Basic Course: ________
Section/Area/Region: _________________
14___ 15___ 16___ 17___ 18___ 19___
Intermediate Course: ___
Telephone: _________________________
Check Advanced Module(s) Completed:
Advanced Course: _____
e-mail: _____________________________
20___ 21___ 22___ 23___ 24___
National Course: ______
Name: _____________________________
Check Basic Module(s) Completed:
Check if Complete Course:
Address: ___________________________
1___ 2___ 3___ 4 ___ 5___ 6___ 7___
U-8 Official Course: ____
City: _______________________________
8___ 9___ 10___ 11___ 12___ 13___
Asst. Ref. Course: ____
State, Zip: __________________________
Check Intermediate Module(s) Completed:
Basic Course: _______
Section/Area/Region: _________________
14___ 15___ 16___ 17___ 18___ 19___
Intermediate Course: __
Telephone: _________________________
Check Advanced Module(s) Completed:
Advanced Course: ____
e-mail: _____________________________
20___ 21___ 22___ 23___ 24___
National Course: _____
Name: _____________________________
Check Basic Module(s) Completed:
Check if Complete Course:
Address: ___________________________
1___ 2___ 3___ 4 ___ 5___ 6___ 7___
U-8 Official Course: ___
City: _______________________________
8___ 9___ 10___ 11___ 12___ 13___
Asst. Ref. Course: _____
State, Zip: __________________________
Check Intermediate Module(s) Completed:
Basic Course: ________
Section/Area/Region: _________________
14___ 15___ 16___ 17___ 18___ 19___
Intermediate Course: ___
Telephone: _________________________
Check Advanced Module(s) Completed:
Advanced Course: _____
e-mail: _____________________________
20___ 21___ 22___ 23___ 24___
National Course: ______
Course ____________ Roster # _________
Instructor _________________________
Page ______ of ______
Name: _____________________________
Check Basic Module(s) Completed:
Check if Complete Course:
Address: ___________________________
1___ 2___ 3___ 4 ___ 5___ 6___ 7___
U-8 Official Course: ____
City: _______________________________
8___ 9___ 10___ 11___ 12___ 13___
Asst. Ref. Course: _____
State, Zip: __________________________
Check Intermediate Module(s) Completed:
Basic Course: ________
Section/Area/Region: _________________
14___ 15___ 16___ 17___ 18___ 19___
Intermediate Course: ___
Telephone: _________________________
Check Advanced Module(s) Completed:
Advanced Course: _____
e-mail: _____________________________
20___ 21___ 22___ 23___ 24___
National Course: ______
Rev. 7/10/03

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Life
Go
Page of 2