NISOA – NSCAA

2003 REFEREE’S SUPPLEMENTAL REPORT FORM FOR MATCH EJECTIONS

This report is to be submitted within 24 hours of the incident.

Please submit a separate report for each person ejected from the game.

IMPORTANT: Please supply ALL requested information.

Game Date: 10.12.2004Scheduled Start Time: 4:00 PMActual Start Time: 4:00 PM

Home Team: BAKER UNIVERSITY Visiting Team: MID-AMERICA NAZARENE Game Site: Baker

Scoring: (HOME TEAM): 1st Half: 2nd Half: OT: Ext.: FINAL:

(VISITOR): 1st Half: 2nd Half: OT: Ext.: FINAL:

Time of Ejection (time into match): 65th Minute Official Scorekeeper Notified: YES NO

Name of Ejected Person: MIKE STONE Team: MID-AMERICA NAZARENE

(Role) Player Coach Ass’t Coach Trainer Other ______

(Gender) Male Player Female Player Male Coach Female Coach

Divisional NCAA I NCAA II NCAA III NAIA I NAIA II

Affiliation: NJCAA NCCAA Other:

Name of Head Coach: Kevin Wardlaw Men’s Game Women’s Game

Institutional Address of Offending Party: 2030 E College Way, Olathe, KS 66062

( street )( City )( State )( Zip )

CAUSE FOR EJECTION: (Check related cause)

1. Violent Conduct or Serious Foul Play2. Foul or Abusive Language3. Persistent Misconduct

( 2nd yellow )

Serious foul play (SFP) Swearing(SW) Conduct related (CR)

Violent Conduct (VC) Crude Language (CL) Language related (LR)

Fighting (FI) Dissent(DS) Combination (CMB)

Spitting (SP) Abusive to official (OF) Persistent Dissent (PD)

Tackle from behind (TB) Abusive to opponent (OP) Other (OT)

Hand ball (unsportsmanlike) (HBU) General, non-directed (GE)

Hand ball (denied goal) (HBDG) Incidental(IN)

Tripping (denied goal)(TRP) Other (describe below) (OT)

BRIEF DESCRIPTION OF INCIDENT (Use back or additional page if additional space is required)

In 65th minute Mid-America Nazarene University assistant coach (Mike Stone) ran at least 10 yards onto the field to protest the awarding of a goal to Baker University. While on the field of play he yelled and hollered while gesticulating his displeasure with the call. I subsequently ejected Mr. Stone from the match. He complied and left the immediate vicinity of the game site.

REFEREE: Ken BartkoskiCHAPTER: Kansas City STATE: MO

AR – 1: John Hale CHAPTER: Kansas City STATE: MO

AR – 2: Bruce Sewell CHAPTER: Kansas City STATE: MO

Alternate: CHAPTER: STATE:

Assignor: Ron Cory CHAPTER: Kansas City STATE: MO

Phone number of individual filing report: 816–246-2171

Choose one of the following methods to submit this report within 24 hours: (listed in order of preference)

Email:or:

Surface Mail:Layton Shoemaker 180 S. Terrace Drive, Dillsburg, PA 17019

Fax (not preferred): 717-730-6747Questions? Phone:717-730-6706 (day)

717-432-9459 (eve)