Florida High School Athletic Association s1
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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