Date: ________________________

YYYY / MM /DD

Name: ______________________ ____________________________

FAMILY NAME GIVEN NAMES

Address: ___________________________________________________

NUMBER STREET NAME AVE/ROAD/STREET/etc.

NUMBER STREET NAME AVE/ROAD/STREET/etc.

FIFA / National / Nom. National ______________________

CURRENT REFEREE STATUS [CIRLE ONE] PROVINCIAL SOCCER ASSOC. REGISTRATION NUMBER

Submit completed Application Form – along with supporting material – to: Mr. Eric Evans, Secretary

757 Millwood Rd. Toronto, ON M4G 1V7

This grant and Award is open to all Canadian Soccer Referees who meet the following criteria:

• FIFA, National or Nominated National status
• Member of their local and/or Provincial Soccer Referees Association for a minimum of 7 years
• Member of the Canadian Soccer Referees’ Association.
• Chosen by a sub-committee of the Canadian Soccer Referees Association made up of 3 – 5 different Provincial organizations plus 2 CSRA executive members.
• Favorable consideration will be given to referees who: have aided and assisted in the management, administration or education of referees within their local/provincial Soccer Referees Association; and provided mentor-ship and guidance to youth and school Referees.
• On the application form, applicants will be required to name the international event they plan to attend and to apply the grant funds. A breakdown of the costs should also be included.
• The recipient of this grant and Award must be committed to the sharing, of the international experience gained, with fellow referees. Collaboration with the CSRA will determine how this will take place.
• More than one recipient of the grant can occur for any one year.

1. Application forms will be available with a list of upcoming international events, from the Secretary of the Canadian Soccer Referees’ Association.
2. Completed application forms, with all accompanying documents, should be sent to the Secretary of the Canadian Soccer Referees Association on or before a specified date each year. (This date may be established once the inaugural event has taken place.)
3. Applicants may apply each year.
4. Applicants must meet the Eligibility Criteria as listed above.
5. Applicants must complete a resume of their academic, social and recreational achievements.
6. Applicants must submit no less than 3 and not more than 5 match and/or project reports outlining their participation in sanctioned symposia, workshops or competitions over the previous 24 months.
7. Not less than 2 and not more than 4 letters of support and endorsements of the applicant must accompany applications. The individuals or organizations providing this support must have known the applicant for at least the past 5 years.