Wayne State College

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Official Application Form

Name: (required)

 

Wayne Address :

 

Email: (required)

 

Home Address :

(include city/state/zip)

Date:

 

Wayne Phone:

 

Cell Phone :

 

Home Phone :

 

 

 

 

Present Classification: FR       SOPH      JR       SR

 

Applying For: (Click all that apply)

Flag Football

 

Softball

 

Basketball

 

Volleyball

Position: (Click all that apply)

Referee

 

Scorekeeper/Timer

 

 

MAJOR:

 

MINOR:

 

 

Please list ANY officiating experience you have had in any sport (Rec Leagues, Little League, High School or College Intramurals, etc...):

 

 

Have you ever been certified some way as an official? Yes       No

If YES, what sports? 

 

 

What sports have you participated in? 

 

 

Please state why you would like to be an Intramural Official (required)

 

 

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