/ HOCKEY CANADA OFFICIATING PROGRAM
OFFICIALS INTERBRANCH TRANSFER FORM /

Complete this form for any official moving/transferring to another CHA Branch, or for an official who is registering with two Branches.

TRANSFERRING OFFICIAL’S INFORMATION: LAST HCOP CLINIC TAKEN INFORMATION:

LAST Name
/ Clinic Location
First Name / Clinic Date
Originating Branch / EXAM Mark / EXAM %
Originating Branch # / HCOP Level Taken / I - II - III - IV - V - VI
Year Started Officating / Yrs Experience at current HCOP level

TRANSFERRING OFFICIAL’S FORWARDING (NEW) ADDRESS & CONTACT INFORMATION:

ADDRESS / HOME PHONE #
CITY / WORK PHONE #
PROVINCE / CELL PHONE #
POSTAL CODE / OTHER PHONE #
DATE OF BIRTH / EMAIL HOME
GENDER / MALE FEMALE / EMAIL WORK

Originating Branch – Referee-In-Chief Referee-In-Chief COMMENTS

Name
TITLE
Authorization
& Signature
DATED
Phone #
Email Address

Originating Branch – Zone/Association/Local RIC or Supervisor Zone/Association/Local RIC or Supervisor COMMENTS

Name
TITLE
Authorization
& Signature
DATED
Phone #
Email Address

Originating Branch – Official’s REFEREE & LINESMAN Ratings/level: {Indicate highest level official has worked or recommend he/she is capable of officiating}

REFEREE Rating
C-Competitive
HL–House League / CIS / M j JR A / TII JR A / JR B/C / Midget / Bantam / Peewee / Atom / WOMEN’s
C- HL- / C- HL- / C- HL- / C- HL- / AAA- CIS- C- HL-
LINESMAN Rating
C-Competitive
HL–House League / CIS / M j JR A / TII JR A / JR B/C / Midget / Bantam / Peewee / Atom / WOMEN’s
C- HL- / C- HL- / C- HL- / C- HL- / AAA- CIS- C- HL-

FORWARDING BRANCH - INFORMATION: {Note Information for the BRANCH the OFFICIAL is moving/transferring to!}

Forwarding BRANCH
BRANCH RIC / Zone/Association RIC
PHONE # / PHONE #
EMAIL / EMAIL

FORWARDING BRANCH - TRANSFER FEES OWING: {Forwarding Branches may have a fee that is required to be paid prior to the official working in that Branch}

BRANCH FEE / PAID? / Yes No

FORWARDING BRANCH - COMMENTS

COMMENTS

ATTACHMENTS: {To assist the forwarding Branch and/or Zone/Association/Local Referee-In-Chief, it is recommended the following information for this official also be emailed/faxed}

Supervisions Attached? / Yes No / # Supervisions / Ref Resume Attached? / Yes No