NIRSA Championship Series

NIRSA Regional Championship Staff Interest Form

NIRSA Regional Basketball Championships staff deadline: November 1, 2014

* denotes required field

Director Positions (rank according to preference): *

Director of Competition

Director of Officials

Committee Positions: *

All-Tournament Committee

Officials Committee

Officials Sub-Committee

Operations Committee

Regional Site Interest (select all that apply): *

University of Maryland

Boston University

University of Massachusetts Amherst

University of Georgia

University of Florida

University of Central Florida

University of Illinois at Urbana-Champaign

University of Dayton

Texas Christian University

University of Nebraska-Lincoln

Eastern Washington University

University of Arizona

Personal Information

* Name

* Institution

* Title

* Email

* Phone

* T-Shirt Size

* Current NIRSA Region

* Years in Campus Rec

* Membership Status

Event Experience

Please describe in detail why you would like to be part of this tournament:

List all NIRSA Championship Series events worked (position, specify National or Regional, tournament site, year)

Other tournament experience (National, Regional, state, other):

Further explanation (if needed):

Define what developing students means to you (In 250 words or less)

If applying for the Director of Officials or for an official’s committee, please answer the following questions:

Are you a current, active sports official?

Yes No - Total # of years officiated:

What sports?
(BB and FFBall only)

Briefly describe your officiating experience in the following areas:
(BB and FFBall only)

Other applicable officiating experience:

  Please note: completion of this form does not guarantee placement on a committee.

NOTE: After submitting your form, you will receive an email confirmation from the NIRSA HQ within 7 business days. If confirmation is not received, please contact


NIRSA Headquarters: 4185 SW Research Way, Corvallis, Oregon 97333-1067
tel: 541-766-8211 • fax: 541-766-8284 • email: