Officials Certification Application
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- Last Updated on Tuesday, 06 January 2015 01:37
- Written by Administrator
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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 _________
