NTBOA Playoff Certification Form

Name:*

Date:*

Member in Good Standing Requirements*
I certify that I am a Member in Good Standing as defined by the Constitution and By-Laws and that I have complied with all the requirements for membership in the State Association and NTBOA.

Yes No

Scrimmages & Assignments Requirements*
I worked a total of 15 NTBOA varsity assignments, of which, no more than 5 of the NTBOA varsity assignments were tournaments. If a dual member, I worked 30 NTBOA varsity assignments as well as completed the scrimmage requirements.

Yes No

Test Scores Requirement*
I made a minimum score of 90% on the following tests: Rules and 3 Person Mechanics.

Yes No

Games & Ethics Requirements*
Have you failed to show or had more than two acts of lateness for game assignments without waiver from the Board of Directors for extenuating circumstances and are you currently on probation or have current ethics violation(s)?

Yes No

Dues Requirements*
Do you have any unpaid dues/fees for the current season?

Yes No

Performance Points Requirements*
I have obtained 6 Performance Points as outlined below:

Yes No

Meeting Performance Points*
Members will earn ONE performance point for each chapter meeting attended. A member must physically attend TWO meetings or they will not be eligible for playoffs. No exceptions given.

0 1 2 3 4 5 6 7

Meeting Dates*
Please enter the dates of meetings attended.

Scrimmage Points*
Members will earn ONE performance point for each chapter assigned scrimmage officiated. A member must participate in at least TWO scrimmages or they will not be playoff eligible. No exceptions given.

1 2 3 4 5

Scrimmage Dates*
Please enter the dates of your scrimmages.

Education Points*
Members will earn ONE performance point for each chapter sponsored training/education session attended. A member must participate in a least TWO education activities or they will not be playoff eligible. No exceptions given.

The October, November & January meetings can be used as an Education point, however, they cannot be used as an education and a meeting point.

Training/Education events include:
NTBOA sponsored camps for staff/campers
NTBOA film sessions
NTBOA education training - pre-determined meetings/trainings
Work a junior high game with a 500-900 ranked official

1 2 3 4 5

Education Dates*
Please enter the dates with a description of your educational opportunity. (Example: 1/5/16 JH Game or June 5-7 NTBOA Camp)

Total Performance Points: Minimum of 6*
Select the total number of performance points you had for the season.

1 2 3 4 5 6 7 8 9 10+

Certification Statement*
I certify, to the best of my knowledge, that I have completed all of the necessary steps in order to be playoff eligible. I understand that checking the box below acts as my signature and that falsifying the information will make me exempt from playoff consideration and a ethics violation will be reported.

Send me a copy of my responses

Email address

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