Referee Certification Application & Answer Sheet
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Ohio Judo, Inc.
REFEREE APPLICATION & EXAMINATION
(Please Print Clearly)
NAME OF EVENT: __________________________ LOCATION:________________ DATE:_____________
NAME OF CANDIDATE: _______________________________________ USJI #: ______________
ADDRESS: _____________________________ ____________________ ________ ______________
Street (& Apt. / PO) City State ZIP
Phones Res.: ( ) _______________ Bus. ( ) ________________ Cell: ( ) _______________
E-MAIL: __________________________ Date of Birth: ____/____/______ Judo Rank: __________
Gender: M F Date of Last Certification: ____/____/______ Certification Level: ______
Years in Judo: _____ Years Refereeing: _____ Approx. # events at this Cert Level: ______
WRITTEN EXAMINATION ANSWER SHEET
1. a b c d 11. a b c d 21. a b c d 31. a b c d 41. a b c d
2. a b c d 12. a b c d 22. a b c d 32. a b c d 42. a b c d
3. a b c d 13. a b c d 23. a b c d 33. a b c d 43. a b c d
4. a b c d 14. a b c d 24. a b c d 34. a b c d 44. a b c d
5. a b c d 15. a b c d 25. a b c d 35. a b c d 45. a b c d
6. a b c d 16. a b c d 26. a b c d 36. a b c d 46. a b c d
7. a b c d 17. a b c d 27. a b c d 37. a b c d 47. a b c d
8. a b c d 18. a b c d 28. a b c d 38. a b c d 48. a b c d
9. a b c d 19. a b c d 29. a b c d 39. a b c d 49. a b c d
10. a b c d 20. a b c d 30. a b c d 40. a b c d 50. a b c d
EXAMINERS: ___________________________ Written Score: __________
Chief Referee
___________________________ Practical Score: __________
Examiner
___________________________ PASS _____ FAIL _____
Examiner
Over for Practical Evaluation
RC Fm NR7-2003
REFEREE PRACTICAL EVALUATION FORM
CANDIDATE:_______________________________________________
REFEREE Pts. JUDGE Pts.
1.________________________________ _____
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2.________________________________ _____
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3.________________________________ _____
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4.________________________________ _____
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6.________________________________ _____
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7.________________________________ _____
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8.________________________________ _____
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9.________________________________ _____
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10._______________________________ _____
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11._______________________________ _____
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Minor Error = 2 pts Procedural Error = 5 pts Gross Error (wrong player wins, etc.) = 25 pts
Presence
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Procedures |
Authority
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Signals (Referee) |
Voice
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Signals (Judge) |
Appreciation
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Penalties |
Observation
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Mobility |
Determination
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Distance |
Over for Application – Written Examination