NJCAA/KJCCC Officials Ejection Form - Kansas Jayhawk Community College Conference

Email address *

Sport *

Gender of Sport *

Date of Incident *

Location of Game (City and State) *

Is home team an NJCAA member College? *

If yes, choose from list below. Otherwise, choose Non-NJCAA member from list below.

Yes No

Home Team *

Non-NJCAA Member School?

Please type name of Non-NJCAA Member School, Otherwise leave blank.

Is visiting team an NJCAA member College? *

If yes, choose from list below. Otherwise, choose Non-NJCAA member from list below.

Yes No

Visiting Team *

Non-NJCAA Member School?

Please type name of Non-NJCAA Member School, Otherwise leave blank.

Name of Ejected Individual *

Team of Ejected Individual *

If Ejected Individual is from Non-KJCCC school, please specify school

Role of Ejected Individual *

Reason for Ejection (Specific Rule Violated) *

Detailed Description of Incident *

Reporting Official's Name *

Reporting Official's Email Address *

Reporting Official's Phone Number *

* required field