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ASSIGNOR’S COMPLAINT REPORT FORM

This form is to be used to report USSF registered assignors who violate the code of ethics, USSF assigning procedures and/or policies, or FSR/FYSA policies. Non-registered assignors are reported to FYSA or FSSA.

This form is not to be used to complain about referees the assignor assigns, if the referee meets the USSF, FSR, and FYSA requirements.

Assignor’s Name

Club

Date of Incident

.

SPECIFIC INFORMATION ABOUT THE INCIDENT

Complaints Name

Phone Number

E-mail Address

Attach any pertinent documentation, written reports of witness’, and/or Referees.

Send information to: Rodney Kenney: E-mail: ckenney@stetson.edu,

Fax: 386-738-6536