Please
print, complete, and mail this application form to:
Kevin
Forrest
60 Gettysburg Ave
Brewer, Maine 04412
Fields Marked * Required
Name*
E-Mail*
Street Address1
Street Address2
City
State
Zip Code
Home Phone
Work Phone
Mobile Phone
Birthdate (not
required)
Gender
Please describe
your experience, if any, with hockey (coaching, officiating, playing,
etc)
Have you experience
officiating other sports? If yes, list the sports and number of
years
Are
you currently a NIHOA official elsewhere? Yes or No. If yes, which
association do you belong to?
Have
you experience coaching or teaching?
If yes, explain
What
is your time availability for officiating?
Weekdays:
Saturdays:
Please
list 3 References* (name, address, phone)
1.
2.
3.
How
did you become interested in officiating high school ice hockey?
This
section is mandated by the Maine Principals Association and
is to be completed annually.
*Have you
ever been convicted of a felony or have felony charge pending?
Yes or No. If Yes, please explain the nature of the conviction
*Have you
ever been convicted of a misdemeanor in the last 5 years Yes
or No. If Yes, please explain. Do NOT include minor traffic
violations
*Are you legally able to work with school age children? Yes or
No If No, please explain
Additional
explanations (if necessary)
Date
and Signature
By
Pressing "Submit", you are validating the following
statement: All answers and statements are true and
complete to the best of my knowledge. I understand Maine
NIHOA may verify information, and that false or misleading
answers could be cause for rejection of this application
or dismissal if a member.
Date
Type Your Full Name
(or signature if you mail this form)
Please
print, complete, and mail this application form to:
Kevin
Forrest
60 Gettysburg Ave
Brewer, Maine 04412