Registered Swimming Officials –Licence Application Form for New

							Registered Swimming Officials –Licence Application Form for New Officials
Please complete this form in BLOCK letters and return to:-
Institute of Swimming, Harold Fern House, Derby Square, Loughborough, Leicestershire, LE11 5AL

ASA/SASA/WASA/IoS                                        Date of Birth:
Membership No:

Title:         1st Name:                                 2nd Name:

Surname:

Address:



Post code:

Home Tel No:

Email address:

Club:

Please tick the
appropriate box or boxes    Judge Level 1                Judge Level 2                 Judge Level 2 S
to denote your current
level of qualification:
I wish to apply for a licence to officiate and can confirm that I agree to abide by the applicable Home Country
Code of Ethics in swimming and accept the applicable Home Country jurisdiction on any breach of the code.
I enclose / have sent by email (delete as appropriate) a non-returnable passport size photograph. (To send
your photograph electronically please use ioslicensing@swimming.org) The photograph must be:
 45 millimetres (mm) high x 35 millimetres (mm) wide (Do not trim your photograph to meet this condition)
 Taken against an off-white, cream or light grey plain background so that your features are clearly
  distinguishable against the background
 Printed on low gloss, plain-white photo-quality paper (with no watermarks, embossing or printing on the
  back
 Undamaged, for example, by creases from paperclips.

I enclose a cheque payable to the Institute of Swimming (IoS) £10.00 and confirm that the information above is
accurate.

Signed:                                                                                        Date:

To be completed by the Regional organiser or authorised person
I confirm the above named person qualified as a ________________________________(insert qualification
obtained)

British Swimming Official on _______________________________(insert date)

Print Name:                 Signature:                   ASA/SASA/WASA/IoS            Date:
                                                         Membership Number




IoS, Harold Fern House, Derby Square, Loughborough, Leicestershire LE11 5AL                            October 2008
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         i
Wh tsteO f il’ ie sn S h me

This scheme will demonstrate that, as well as holding a recognised qualification, the Official regularly practises
on the poolside, and has undertaken education or training to ensure they are up to date with their knowledge
of the rules of the sport.

Why do we need to have a Licensing Scheme?

 T si me t ra i in the selection of Officials
      s
• oa s t e og n  sers
 T rv e u
       d        r s e n o q afai s n x ei c
                    a          i o
                                i
• opo i as mmay ttme t f u lc t n a de p r n e   e
 T e o rmoe i t d rs
     p          g a
• oh l t po t h hs n ad
 T rv e r w r fr o t u u i rv me t n o t u u Poe s n l e e p n C D
       d   a            n                         n         o    o
• opo i af me ok o c ni o smpo e n a dC ni o s rfsi a D v l me t P )
 T rv e e iewhich can be used to implement change
       d     c
• opo i av h l
 T o t e o e t p o h p rpi e o
         t    d       d
• oc mmi h h l rou h l tea po r t H meC u t C d o Eh sns i n
                                   a             y        c
                                              o nr o e f ti i wmmig
 T e at f e u td n e e p g ae r t c e
                a         on
• ob p ro arg l e a dd v l i c re s u tr  r u
 T n b h u p n i re v l fh t u
       e           o
• oe a l tes s e s no rmo a o tes ts a

Who administers the Scheme?

The Scheme will be administered by the Institute of Swimming (IoS).

What does it cost?

£10 to cover a 4 year accreditation period.

What benefits are there?

 P oo rp i d tc t n
          c e f o
• h tga h i ni ai  i
 Of a l o k
   i l g
   c
• f iso b o
 E t c f IA a s
   r s
• x a t o FN L w
 Ade
• i -memoire for reporting of infringements of the Rules
 S b is
     d e P p ot i s
• u s i dC Do p r n i ut   e

How to apply for a Licence

The application form must be completed by you, endorsed by the regional organiser and forwarded to the IoS,
together with the fee and a passport photograph.




IoS, Harold Fern House, Derby Square, Loughborough, Leicestershire LE11 5AL                            October 2008