ACSA OFFICIAL CERTIFICATION APPLICATION

Adult Competitive Sports Association (ACSA)
Annual Certification

The Adult Competitive Sports Association (ACSA) certifies officials who officiate in ACSA-sanctioned leagues and competitions across Alabama.

Certification establishes eligibility for assignment in sanctioned leagues, participation in championship events, and inclusion in the ACSA Certified Officials Registry.

Annual Certification Fees:
• Single Sport Certification — $35

Certification is valid for one (1) year from date of approval.

ACSA OFFICIAL CERTIFICATION APPLICATION

SECTION 1

Personal Information

First Name*

Last Name*

Primary Email*

Company Name

Are you representing a company? If yes, complete this field with your official Company Name. If you are not representing a company, then please enable the switch below labeled "I'm not representing a Company".

Primary Phone*

Full Address*

Date of Birth*

Emergency Contact Name

Emergency Contact Phone Number

SECTION 2

Officiating Background

Sports You Currently Officiate*

Primary Sport Applying for ACSA Certification*

Certification Type*

Years of Officiating Experience*

Current Assignor or Officiating Association (if applicable)

Example: local referee association, school association, independent assignor

SECTION 3

Primary Officiating Region

City / Area where you typically officiate:*

SECTION 4

Insurance Disclosure

Do you currently carry referee liability insurance?*

If YES, who is your Insurance Provider / Association:

Policy Expiration Date:

Upload Certificate of Insurance (if available)

Note: ACSA may require proof of coverage for participation in certain sanctioned events.

SECTION 5

Eligibility & Professional Standing

Have you ever been suspended, sanctioned, or removed from officiating duties by a league, school association, or governing body?*

If yes, please explain:

Are you currently in good standing with your primary officiating association or assignor?*

SECTION 6

ACSA Governance & Professional Standards

SECTION 7

Disciplinary Procedures & Appeals

SECTION 8

Electronic Signature

Signature Block

Signature

Signature Block

By submitting this application, I certify that the information provided is accurate and complete.