Rev. ϵ-ϱ-20
As a PDF, this is a fillable form. Download, save it to your computer. Once saved, open saved copy,
fill it out, save again. It can then be added as an attachment to be sent through the chain-of-command.
REGIONAL COMMISSIONER CHECKLIST
Name:
Section: Area: Region:
Appointment: Reappointment:
If reappointment, years served: _______
Appointment/Reappointment less than 3 years? Yes No If YES include explanation:
____________________________________________________________________________________________________________
This section for RC to complete
If the RC is a “new elect”, all 7 members have 3 months to complete training. If the RC is a “re-elect” all positions must have training
completed prior to submitting to the Section Director
• All 7 positions listed below must be identified with the volunteer’s name and training information
• All volunteers must be registered for the current Membership Year (MY), prior to signing and submitting to the Section
Director.
All 7 positions listed must have completed:
• Safe Haven (SH - after 2011)
• CDC Concussion Training
• Sudden Cardiac Arrest (SCA) is now required for volunteers in the following states: California, Maryland, Ohio, Tennessee
and Washington
o For more specific information, please go to https://www.aysovolunteers.org/sudden-cardiac-arrest-sca-2/
• Training for their job specific duties (JST).
All boxes must be checked before form can be submitted to the Area Director.
*RCT-Regional Commissioner Training; *JST-Job Specific Training; *SH-AYSO Safe Haven; *CDC-Concussion Training; *SCA-Sudden
Cardiac Arrest; *DR-Dispute Resolution; *DP-Due Process; *T-Treasurer; *MY-Membership Year
This section for AD to complete, save, and forward to the SD
YES NO
Conflict of Interest Form (2 pages) initialed/signed as required and attached.
Region is using NAP Online & current year budget has been uploaded to NAP Online.
If not, upload or provide with this application.
RC Training completed (RCT).
PA residents - State required background clearances submitted. If not, submit with this application.
______________________________ ______________________________ ______________________________ _____________
Regional Commissioner Area Director Section Director Date
