U.S. Figure Skating Judges Committee Nomination for Provisional Competition Judge

The following two-page nomination form should be used by any club and/or monitor submitting a candidate for provisional singles/pairs, provisional dance or provisional synchronized skating competition judge.

This form is designed to be completed electronically. Use your tab key to navigate between the fields that need to be completed, and then type the information as usual. If you would prefer to complete the application by hand, you may do so by printing the application and writing in the requested information.

Make sure you complete all portions of the application and attach any information that is requested.

Completed forms should be sent to the following Judges Committee vice chair for the region or section in which the nominee resides (per rule JR 11.13):  The appropriate regional vice chair (RVC) for singles/pairs for provisional singles/pairs competition judge nominations;  The appropriate regional vice chair (RVC) for dance for provisional dance competition judge nominations;  The sectional vice chair (SVC) for synchronized skating for provisional synchronized skating competition judge nominations.

The names and contact information for the Judges Committee RVCs and SVCs can be found on the U.S. Figure Skating website at http://www.usfigureskating.org/Story.asp?type=leadership&id=850.

For complete information on applying for an appointment, please see rules JR 11.00-JR 11.23 in the current U.S. Figure Skating Rulebook, which can be found online at www.usfigureskatingrules.org.

Please print or type clearly. A separate application is required for each appointment.

Application for appointment as a: Provisional judge Date:

Type of candidate (select one): Standard Accelerated Advanced Select

Candidate’s Personal Information Name: Member #:

Address:

City: State: Zip:

Home Phone: Office Phone:

Fax Number: E-mail address:

Home Club: Occupation:

Candidate’s Present Status Present classification as test judge and date of appointment:

Has the candidate ever applied for this appointment before? No Yes – if yes, give date:

Has the candidate ever been an ineligible person? No Yes – if yes, give date of reinstatement:

1 JC-13 REV 07/13 Appointment Qualifications U.S. Figure Skating Tests passed and dates:

Moves: Free Skate:

Pairs: Dance:

Figure: Synchronized:

Current skating activity:

Club/U.S. Figure Skating related activities:

If candidate has attended any Judges schools for this appointment please list location and dates (attach certificates or request verification from HQ):

If candidate has trial judged any competitions, attach summary sheets with deviations indicated or IJS worksheets.

A candidate applying for appointment at any level, except national, will be notified of the action taken by the committee within 60 days of receipt of the application.

NOMINATOR

Candidate’s Home Club Representative or Monitor To the best of my knowledge, the candidate has reached the age of 18* and his/her qualifications meet all the requirements for the appointment requested. *Persons 17 years of age may be appointed as judges provided they have been actively trial judging for a minimum of six months and meet the guidelines for appointment.

Club Official Monitor (Please circle) (Please print name and officiating status)

Signature: Date:

APPROVALS

Regional Vice Chair, Sectional Vice Chair Review by Regional Vice Chair

Signature : Date:

Review by Sectional Vice Chair

Signature: Date:

APPLICATION IS: GRANTED REJECTED DATE:

2 JC-13 REV 07/13