PENNSYLVANIA INTERSCHOLASTIC ATHLETIC ASSOCIATION, INC.

550 Gettysburg Road, P. O. Box 2008,  Mechanicsburg, PA 17055-0708

Fax: 717/697-7721 • Website: www.piaa.org

APPLICATION FOR REGISTRATION

 Mr. Bradley R. Cashman, PIAA Executive Director                         Phone: (717) 697-0374 or (800) 382-1392

(PLEASE PRINT USING BLACK INK OR TYPE USING BLACK RIBBON)
I hereby apply for registration as a PIAA Official in the sports checked.
The non-refundable officials’ application fee, payable to PIAA, of $25.00 is enclosed.
 

Date

Social Security Number

Home Phone No. (        )

Ms./Mr.

Business Phone No. (        )

Home Address

Street                                                                Town                                  County                            State                        Zip Code

APPLICANTS ARE LIMITED TO ONE (1) EXAM PER TEST DATE

SPORTS - (You may select a minimum of one (1) and a maximum of three (3) sports you want to officiate.)

Baseball

Soccer

New Application           ____Yes    ____No

Basketball

Softball

Transfer from another state

Field Hockey

Swimming & Diving

(List state)

Football

Track & Field

 If transfer from another state,

Girls' Gymnastics

Volleyball

 Submit appropriate I.D. Card

Girls' Lacrosse

Wrestling

This application must be filed in the PIAA Office at least ten (10) business days prior to the examination date to be eligible to take the officials' examination in the sports) checked above.

DATE OF EXAMINATIONS: Please check the date when you plan to take the examination. All sports examinations will be given on the following dates:

First Monday in June (June 2, 2003)

First Monday in October (October 6, 2003)

PIAA Officials' Convention (Friday, August 8, 2003)

First Monday in February (February 2, 2004)

PLEASE NOTE THAT UPON RECEIPT OF THE APPLICATION, YOU WILL RECEIVE THE APPROPRIATE
RULES BOOKS AND INFORMATION ON SITES AND TIMES FOR EACH TESTING SITE.
APPLICANTS ARE LIMITED TO ONE (1) TEST PER TEST DATE.

SITES - Check the location where you will take the examination

Dist

Location

Dist

Location

1

Upper Merion H. S., King of Prussia

6

Hollidaysburg H. S., Hollidaysburg

2