ATLANTA PEACH STATE FOOTBALL OFFICIALS ASSOCIAITON

Required information to

APPLY FOR REGISTRATION TO OFFICIATE HIGH SCHOOL SPORTS IN GEORGIA

Name

                                Last      First    Middle Initial

Social Security Number

                             

Mailing Address

                                (Street of P.O. Box)                                                        (City)     (State)   (Zip Code)

Age

Home Phone

Business Phone

Cell Phone

Email Address

Education

                              (High School Graduate)   (GED)  (College Graduate)

Occupation

Emergency Contact Information 

Have you ever been convicted of one of the following crimes:  sexual offense of any kind, crime against a minor, a drug-related offense in the past 10 years, DUI in the past 5 years gambling?                          Yes                             No

            (If “Yes”, give full particulars about the offense (including the date and place of conviction) in the box below)                 

OFFICIATING EXPERIENCE

Sport of Registration

Number of years officiating above sport:                       High School                                College

Do you have prior officiating experience with the GHSA?    Yes /  No

If “Yes”, what sport?                                              What Association?                                             What Year?

Do you have prior officiating experience in another state?   Yes /  No

If “Yes”, what state?                                       What sports?                                                            How Long?

(Note: It is the responsibility of the official to contact the former state high school association to have records sent to the GHSA.

Records needed per sport are: years of experience, last year’s clinic attendance, games worked, exam scores and current rating.)

Click Here to Submit this to Association Secretary - David Hallquist

(Your SSN will only be viewable by the Secretary and Treasurer)