Staff Camp Tryout "*" indicates required fields Name* Session*Session I: Saturday, June 17, 2023 @ Thomas Jefferson University (“Old” Philadelphia University located at 4201 Henry Avenue, Philadelphia, PA 19144 held in conjunction with Philly Live HS tournament.Session II: . Saturday, June 24, 2023 @ Thomas Jefferson University (“Old” Philadelphia University located at 4201 Henry Avenue, Philadelphia, PA 19144 held in conjunction with Philly Live HS tournament.Email* Cell Phone Number*Mailing Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Number of years officiating experience:*1234567891011121314151617181920212223242526272829303132333435363738394041424344454647484950Level currently officiating: (Check all that apply)* Division I Division II Division III JUCO Have you ever officiated in the NCAA Tournament?* Yes No Level (Check all that apply)* Division I Division II Division III Current Collegiate Supervisors for whom you are officiating: (Check all that apply)* Larry Last Mike Stephens Tim Ebersole Mike Kitts Tom Reinisch Jack Sweeney Mike Chesney Donnie Eppley Bob Pugh Other: College supervisor (Other): Additional Comments:
