Complete this form and click the Submit Request for Assessment button to send your information to the State Director of Assessment. You will receive an email confirmation of your request.

Concurrent with the sending of the Request for Assessment, you must go to GameOfficials, identity 1234, courses, course 25153 WisRef Assessment Payment Course Only, sign up for and pay for the course.  The course, or assessment fee is $65, which will be charged to your credit card.

Name:
Address:
City, State & Zip: ,
Email:
Phone:
Current Referee Grade: 98765
Assessment Type: UpgradeRetention
Position: RefereeAssistant Referee
Game #: from WisRef.GameOfficials.net assignment
League: as in GameOfficials
Game Date/Time: : ampm
Comments:
Answer: (prevents spam)
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