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Request a Clinic


Are you a Club, Association, or an Instructor? Do you wish to host a Clinic in your area for Referee Training?

Fill out the form below and submit your request. It will be sent to the State Director of Instruction (SDI), R. C. (Chip) Walaska, at All areas of the form must be filled out unless indicated otherwise.

IMPORTANT: After you have submitted the Form, please call the SDI at 319-651-7404 to confirm receipt of your clinic request, discuss the particulars of the class, and to get any questions answered.

We will make every attempt to honor requests from Organizations, Clubs, Referee Associations, Assignors or Registered Instructors as the schedule permits. We suggest that you check the Calendar of Events to see if there are any major conflicts with your date(s), e.g., with the annual Terry Vaughn Referee Academy, prior to submitting your request.

Most instructor-led Grassroots Referee Clinics last a full day, e.g., 9:00 a.m. to 5:00 p.m. on a Saturday. The Clinic Sponsor will need to provide a Classroom with tables and chairs. The Classroom may also need a blackboard / white board or flipchart easel and paper. The Instructor may require a Projector and Screen for PowerPoint presentation / slide projection. The Clinic Sponsor is responsible for recruiting students and a Club Representative must be on site during the class.

NOTE: The Clinic Sponsor must guarantee at least 10 paid participants. If not, the Clinic Sponsor must make up the cost difference.


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6200 Aurora Ave., Suite 607E
Urbandale, IA 50322
Tel: 515.252.6363

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