Officials Certification Application

 

OJI OFFICIALS CERTIFICATION APPLICATION

NAME   ______________________________________      DOB _______________________

ADDRESS __________________________________________________________________

CITY ___________________________________________    STATE  _____  ZIP _________

PHONE (HOME) ______________________________      (BUSINESS) _________________

E-MAIL _____________________________________________________________________

 

JUDO HISTORY   Date Started __________  Current OJI Number ______________________

Current Rank _________________  DOR ______________   Issued by (Org.) _____________

 

Certification being applied for(circle the appropriate one):

 

Timer-Apprentice;   Timer-OJI;   Scorer-Specialty;   Scorer-General;

 

Head Timer/Scorer;   Referee-Local (L);   Referee-State (R1);  State (R2);  State (R3)

 

INITIAL CERTIFICATION ____      OR     RECERTIFICATION ____

 

PREVIOUS CERTIFICATIONS

 

LEVEL             PLACE OF CERT.              DATE OF CERT.            EXPIRED(DATE)

______      ____________________      _____________          _______________

______      ____________________      _____________          _______________

______      ____________________      _____________          _______________    

______      ____________________      _____________          _______________

 

PERFORMANCE TOWARD CERTIFICATION

 

DATE             EVENT                      FUNCTION           QUANTITATIVE  EFFORT

_______      _______________    ____________     _________________________

_______      _______________    ____________     _________________________

_______      _______________    ____________     _________________________

_______      _______________    ____________     _________________________

 

************************    FOR OJI USE ONLY    ****************************

WRITTEN SCORE _____ (____ REQUIRED);   PRACTICAL (Demo) ______ (_____ REQ'D)

FEES PAID:_____    TESTED BY ____________________     PASSED _____   FAILED ____

INFO.REGISTERED __________   CERTIFICATE SENT _________    SENT BY _________

2019  OhioJudo.Org  globbers joomla templates