NTBOA 2016-17 Season Playoff Certification Form






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. I am not a dual member and I only accept officiating assignments, at the high school level, from NTBOA.


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.


I made a minimum score of 90% on the following tests: Rules 1, Rules II (PPO) and 3 Person Mechanics.


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)?


Do you have any unpaid turn back fees for the current season?


I have obtained 6 Performance Points as outlined below:


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.


Please enter the dates of meetings attended.


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.


Please enter the dates of your scrimmages.


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.

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



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


Select the total number of performance points you had for the season.







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