2014-15 NAIA Basketball National Tournaments

Officials Application Form

RECEIPT DEADLINE: December 31, 2014

RETURN NOMINATION FORM AND SUPPORT MATERIAL TO:

Larry Lady, NAIA Basketball National Supervisor of Officials, 15221 Midland Drive, Shawnee Mission, KS 66217

(Please complete this form in Microsoft Word)

Please Select : Mens Womens
Name: / Address:
City, St, Zip: / E-mail Address:
Telephone (Home): / (Work): / (Cell):
Height: / Weight: / Date of Birth: / Social Security Number:
Number of Years Officiating College Basketball:
Conference or other Officiating Chapter Member:
Major Postseason Events Previously Worked:

Key References (Supervisor of Officials, Conference Commissioner, etc.):

Name / Title / Home Phone / Work Phone
Name / Title / Home Phone / Work Phone
IMPORTANT! PLEASE ATTACH THE FOLLOWING:
1. / Letter of application from the prospective official indicating desire to work the NAIA Basketball National Championship.
2. / Personal resume’ highlighting officiating career to date.
3. / Recent jpeg electronic photo to Larry Lady:
4. / Officiating schedule from the previous season including regular season and postseason assignments. Schedules should include dates, opponents, site and partner(s) for each contest.
5. / Officiating schedule for 2014-2015. Schedule should include dates, opponents, site and partner(s) for each contest.
6. / Minimum of three (3) letters of recommendation to include the Affiliated Conference/A.I.I. Commissioner, Supervisor of Officials, and one other.
7. / VIDEOTAPE or DVD from POSTSEASON play 2013-14, if possible. If unavailable, send a hotly contested LATE season conference game. One of the two videotape options MUST be included.
NAIA Conference / supports the above official for the NAIA Basketball national tournament.
Conference Commissioner Signature / Institution/Date
Conference Supervisor of Officials Signature / Institution/Date

NAIA National Office • 1200 Grand Blvd., Kansas City, MO 64106 • 816.595.8000 NAIA Basketball Officials Application Form / 09-14