FLORIDA HIGH SCHOOL ATHLETIC ASSOCIATION Wrestling Weight Monitoring Program 2017-18 Assessor Application Form

Directions: Please print or type.

Name: ______Date of Birth: ___/____/______

E-Mail Address: ______

Address: ______City: ______FL Zip: ______

Phone: Day (____) ____ - ______Home (____) ____ - ______Cell (____) _____ - ______

Current Employer: ______

CHECK THE APPROPRIATE BOX  First Time Registrant (assessor workshop needed, Watched Online Assessor Training)  Renewal (attended assessor workshop during last school year)  Lapsed Registrant (none attended since 2015-16 school year, Watched Online Assessor Training)

Certification Workshop: 1.) Training: ______

2.) Completion Date: ______

IN ORDER TO PERFORM THE DUTIES OF AN FHSAA ASSESSOR, YOU MUST COMPLETE THIS REGISTRATION FORM EVERY YEAR. Relevant Background (degrees attained, certification held):

Signature: ______Date: ______

A $20.00 NON-REFUNDABLE APPLICATION FEE MUST ACCOMPANY THIS APPLICATION.

Return to: Wrestling Assessors FHSAA 1801 NW 80th Blvd. Gainesville, FL 32606

Pay online: https://squareup.com/store/fhsaa/item/assessor-fee

WRassessorAPP2017-18 Rev8/17