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TO Form test
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TO Form test
1
Your Details
2
Accreditation Details
3
Submit
Which is the applicable MSA State Branch responsible for the training in relation to this application?
(Required)
select the Branch that conducted the training for the accreditation/re-accreditation on this form
New South Wales
Northern Territory
Queensland
South Australia
Tasmania
Victoria
Western Australia
Who is completing this form?
(Required)
the applicant for Technical Official accreditation/re-accreditation
the MSA Branch Technical Official Co-ordinator
Applicant's Name
(Required)
First
Last
Applicant's Email
(Required)
Is, or has the applicant peviously been, a registered MSA member?
(Required)
Yes
No
MSA member number, if known
Does the applicant have an existing MSA Technical ID No?
(Required)
Yes
No
MSA Technical ID number, if known
Has the applicant been previously registered with MSA, or held MSA Technical accreditation, under another name?
No
Yes
Previous Name
First
Last
Personal Details
Required where the applicant is not a current or former member.
Date of Birth
Day
Month
Year
Gender
Male
Female
Address
Street Address
Address Line 2
City
State
Postcode
Country
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Congo
Congo, Democratic Republic of the
Cook Islands
Costa Rica
Croatia
Cuba
Curaçao
Cyprus
Czechia
Côte d'Ivoire
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, Democratic People's Republic of
Korea, Republic of
Kuwait
Kyrgyzstan
Lao People's Democratic Republic
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Romania
Russian Federation
Rwanda
Réunion
Saint Barthélemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syria Arab Republic
Taiwan
Tajikistan
Tanzania, the United Republic of
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkmenistan
Turks and Caicos Islands
Tuvalu
Türkiye
US Minor Outlying Islands
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Venezuela
Viet Nam
Virgin Islands, British
Virgin Islands, U.S.
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Ã…land Islands
Phone
Position Name
(Required)
Timekeeper
Chief Timekeeper
Check Starter/Clerk of Course/Marshal
Starter
Judge of Stroke
Inspector of Turns
Referee
Timekeeper
This field is hidden when viewing the form
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course number, if known
Course Date
DD slash MM slash YYYY
Chief Timekeeper
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course number, if known
Course Date
DD slash MM slash YYYY
Check Starter/Clerk of Course/Marshal
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course number, if known
Course Date
DD slash MM slash YYYY
Starter
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course number, if known
Course Date
DD slash MM slash YYYY
Judge of Stroke
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course number, if known
Course Date
DD slash MM slash YYYY
Inspector of Turns
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course number, if known
Course Date
DD slash MM slash YYYY
Referee
Accreditation Type
(Required)
New Accreditation
Re-accreditation
Please tick each of the activities you have completed in the past four years, noting the below activities are compulsory:
Performance has been assessed as competent by a peer
Maintained competency over past 24 months as recorded and assessed in position
Attended all seminars on Procedure or Rule changes, or
Have completed email assignment on Procedure or Rule changes
Completed a refresher course
Name of Assessor
First
Last
Course Number, if known
Course Date
DD slash MM slash YYYY
Comments
Untitled
First Choice
Second Choice
Third Choice
Home
About
About Us
Officers of the Association
State/Territory and Clubs
Insurance Information
MSA Awards
Annual Reports
Stories of our Swimmers
Coaching and Technical Officials
Archive
MSA Merchandise
MSA Mental Health Awareness Hub
Clubs
Find a masters Club
Swim Aus – Swim Finder
Programs
Endurance 1000 Program
Million Metres Program
National Swim Series
Transition 2 Masters (T2M)
News
Posts
e-News
Events
Rules and Policies
Member Protection
MSA Strategic Plan 2024-2027
Insurance Information
Annual Reports
MSA: Q & A
Swim Central
2024 Membership Instructions
Login
FAQs for Members
FAQs for Club Administrators
Swim Aus Swim Central Support Centre
Swim Aus – Swim Finder
QUEENSLAND
NEW SOUTH WALES
NORTHERN TERRITORY
SOUTH AUSTRALIA
TASMANIA
VICTORIA
WESTERN AUSTRALIA
