Belgrade Youth Baseball Coach Evaluation Questionnaire Page 5
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5LITTLE LEAGUE
BASEBALL AND SOFTBALL TOURNAMENT UMPIRE REQUEST FORM
®
20____
Requests must be sent in to your Regional Director annually prior to November 1st to keep names active.
NOTE: Your District Administrator must recommend you for all assignments requested.
Name:____________________________________________________________________________________________
Address:__________________________________________________________________________________________
Street
City
State
Zip
Telephone: Home:(_____)__________________ Work:(_____)___________________ Cell: (_____)_______________
E-Mail: __________________________________________________________________________________________
*********************************************************************************************
REQUESTING ASSIGNMENT (Mark only one)
REGIONAL__________________ WORLD SERIES______________________
BASEBALL:
LL_________ JR _______ INT ________SR________ BL___________
SOFTBALL:
LL_________ JR________ SR________ BL___________
LITTLE LEAGUE VOLUNTEER UMPIRING EXPERIENCE: (Most Recent Listed First)
1. WORLD SERIES EXPERIENCE (indicate the year in which you umpired each series
Baseball:
LL _______
JR _______
INT_______
SR _______
BL _______
Softball:
LL_______
JR _______
ISR _______
BL _______
2. REGIONAL TOURNAMENT EXPERIENCE (indicate the year in which you umpired each regional)
Baseball:
LL _______
JR _______
INT_______
SR _______
BL _______
Softball:
LL _______
JR _______
SR _______
BL _______
3. Are you presently a member of the Umpire Registry?
pYES
pNO
4. Have you ever attended a Little League Umpire School?
pYES
pNO
If yes, year attended and where: _____________________________________________________________
5. Indicate the number of years you have been a volunteer umpire for any level of Little League Baseball and/or
Softball? pLess than 5 years p5 to 10 years p10 to 15 years p15 to 20 years pmore than 20 years
6. I certify that I am currently involved in the program as a volunteer Little League umpire and have not received
payment for umpiring Little League games and that I will accept, if offered, an assignment.
7. I certify that I have not had a break in service with the Little League program. If you have left the program,
indicate the year in which you returned ____________________.
Umpire Signature: ______________________________________ Date: _______________________
I hereby nominate and approve the application of this Umpire for consideration to the Tournament(s) that he or she
has requested, and certify that the information presented is accurate, to the best of my knowledge.
STATE _____________________
DISTRICT NUMBER ____________________________
DISTRICT ADMINISTRATOR SIGNATURE________________________________ DATE: _________________
NOTE: Forms received after November 1st will not be considered.
DO NOT SEND RESUMES OR ANY OTHER ADDITIONAL INFORMATION.
Complete Volunteer Application on back of this form.
A copy of a valid government-issued photo ID MUST accompany form.
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