<p> FLORIDA HIGH SCHOOL ATHLETIC ASSOCIATION Wrestling Weight Monitoring Program 2017-18 Assessor Application Form</p><p>Directions: Please print or type.</p><p>Name: ______Date of Birth: ___/____/______</p><p>E-Mail Address: ______</p><p>Address: ______City: ______FL Zip: ______</p><p>Phone: Day (____) ____ - ______Home (____) ____ - ______Cell (____) _____ - ______</p><p>Current Employer: ______</p><p>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)</p><p>Certification Workshop: 1.) Training: ______</p><p>2.) Completion Date: ______</p><p>IN ORDER TO PERFORM THE DUTIES OF AN FHSAA ASSESSOR, YOU MUST COMPLETE THIS REGISTRATION FORM EVERY YEAR. Relevant Background (degrees attained, certification held):</p><p>Signature: ______Date: ______</p><p>A $20.00 NON-REFUNDABLE APPLICATION FEE MUST ACCOMPANY THIS APPLICATION. </p><p>Return to: Wrestling Assessors FHSAA 1801 NW 80th Blvd. Gainesville, FL 32606</p><p>Pay online: https://squareup.com/store/fhsaa/item/assessor-fee</p><p>WRassessorAPP2017-18 Rev8/17</p>