Official Application CSI Senior Championship

July 9-12, 2015 @ Wesleyan University

Contact Information
First Name:*
Last Name:*
Preferred Phone Number:
Select the gender of your athlete(s) competing in the meet:* Female Male Both None

Club and Certification
Indicate Club Affiliation:
CT Club Code:*
Your LSC highest level of certification:* Administrative Official Stroke & Turn Chief Judge Starter Referee
Do you have previous championship meet experience?* Yes No
Do you still need one (1) Championship Meet (Regionals, Age Group or Seniors) work session for CT Officials re-certification?* Yes No Not Sure
If applicable, please list your USA Swimming national certifications:

Select sessions you are available to work.
Morning Preliminary Sessions:
Evening Final Sessions:

National Officials Qualifying Meet (OQM)

This meet is designated as a National Officials Qualifying Meet (OQM). Evaluators will be in attendance for certification and re-certification evaluations at all N2 & N3 levels, except Administrative Referee.

  • N2 evaluations must each be done over 3 sessions in the position at the meet.
  • N3 evaluations must each be done over 4 sessions in the position at the meet.
  • Recertification evaluations must each be done over 2 sessions at the meet.
  • ALL officials seeking evaluations must work a total of at least 4 sessions at the meet.
I would like a National Evaluation:* Yes No
Evaluate for Certification (see options below): Yes No
Evaluation for Recertification (indicate position below): Yes No
Certifications: Request evaluation for certification for the following position(s): N2 S&T, N3 S&T, N2 CJ, N3 CJ (Initial), N3 CJ (Final), N2 Starter, N3 Starter (Initial), N3 Starter (Final), N2 Deck Referee, N3 Deck Referee (Initial),or N3 Deck Referee (Final):
I have or will have all the appropriate requirements (Certifications and Recertifications) for potential advancement to the position(s) being evaluated:* Yes No

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