Request for Assessment

Directions for completing Assessment Request:

  1. Contact your Assignor for an appropriate game level match assignment.
  2. Accept the appropriate Game level match assignment.  NOTE:  Only matches with 45 minutes halves are acceptable.
  3. Complete the all of the fields in the form shown below and submit to Your SDA no later than one (1) week prior to the match date.
  4. NOTE:  No Assessments will be scheduled until payment, in full, has been received.
  5. Pay the Assessment fee and Administration fee.  Mail check payable to SRA, PO Box 495, Wheat Ridge, CO 80034.  See Assessment page for list of fees.  Submit your Game Log and Colorado Instruction, Assessment & Fitness Testing Record Book at the same time. These documents can be downloaded from the COReferees Administration page.
  6. Upon clicking the button at the bottom of this form, an email will be sent to your SDA with a copy to you.
  7. Your SDA will respond with a reply to this request indicating that the request has been received.
  8. Your SDA will respond with an additional email confirming that an Assessor has been assigned.

Referee Information: (*: Required Fields)

Your Name: *
Your Email Address: *
Your Phone Number: (###-###-####)
Your Current Grade: *
Requesting Assessment Type: *
Position Being Assessed: *
Fees Payable: * 
Fitness Test Date (mm/dd/yyyy date format): *

Assignor Information: (*: Required Fields)

Assignor Name: *
Assignor Email Address: *
Assignor Phone Number: (###-###-####)

Match Information: (*: Required Fields)

Date of Match (mm/dd/yyyy format):

* (7 or more days from today)

 Time of Match: *    
Location (Complex/Field/Park) * Field #:    
Level of Match: * If Other:    
League: Division:    
Game Number (if known):        

Additional Information from Referee:

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