USA Volleyball
National Referee Candidate
Recommendation Form
2015-16 Season
CANDIDATE’S NAME:
This certifies that I have observed the above USA Volleyball Junior National referee as both a first and second
referee for an entire match within the past 18 months while using USAV/FIVB rules, and I am recommending this
referee to be considered by the USA Volleyball National Indoor Officials Commission, Director and Assistant Director
for Referee Evaluation and Certification, as a candidate for USAV National Referee certification at the 2016 Junior
National Championships.
I have most recently observed this referee:
Date:
Site:
My role with USA Volleyball (check ONLY one):
**Must have held or currently hold a USAV/PAVO national referee certification
USAV National Indoor Commission member, referee group
USAV National Rating Team member (during at least one of the past three seasons)
USAV National Training Team member (during at least one of the past three seasons)
USAV National Championship/GJN Qualifiers or Boys Bid Tournament head referee
Check one:
US Open
Girls’ JNC
Boys’ JNC
**Qualifier/Boys Bid
List Girls Qualifier or Boys Bid Tournament___________________________________
High Performance Championships head referee or international/national trainer
Current International Referee (Not a candidate/retired)
**NCAA/DI Conference Coordinators or Assignors (limited to one signature)
**NCVF head referees (limited to one signature)
**Regional referee/officials chairs (limited to one signature per region)
Recommended by (print):
Primary Email:
Cell Phone:
Recommended by: _______________________________________________________
(signature)
Document1
REV. May 2015