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 or Dev Academy U16 matches are acceptable.
  3. Complete all of the fields in the form shown below. Requests must be submitted to Your SDA no later than one (1) week prior to the match date.
  4. Submit your completed Game Log and Colorado Instruction, Assessment & Fitness Testing Record Book. These documents can be downloaded from the COReferees Administration page.
  5. There are two methods of payment:
    • To pay On-Line, by Credit Card, click the button at the bottom of this form. A Credit Card payment form will be displayed.
    • To pay by mailing a check, click the button at the bottom of this form. A Confirmation of your Request will be emailed to your SDA with a copy to you. Mail check payable to SRA, PO Box 495, Wheat Ridge, CO 80034.
      NOTE:  No Assessments will be scheduled until payment, in full, has been received.
  6. Your SDA will respond with a reply to this request indicating that the request has been received.
  7. Your SDA will respond with an additional email confirming that an Assessor has been assigned.
  8. NOTE:  Yahoo and AOL email addresses get flagged as SPAM by Yahoo and AOL mail servers.  They use a very restrictive automated algorithm.  If you have another email address, i.e., gmail, please use it in order to complete your request.

Referee Information: (: Required Fields)

Your Name:
Your Email Address: (No Yahoo addresses) (Yahoo addresses flagged as SPAM)
Your Phone Number: (###-###-####)
Your Current Grade:
Requesting Assessment Type:
Position Being Assessed:
  Fees Payable: (Display Fee Table) $
Fitness Test Date (mm/dd/yyyy date format):

Assignor Information:

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

Match Information:

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

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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