NOTE: Fill blanks and secure signatures. Send to the Executive Director of the Delaware Interscholastic Athletic Association.

To the Committee on Interscholastic Records:

Application is hereby made for a STATE RECORD in the (Event) ____________________________________________

The performance was in the (name of meet) _____________________________________________________________

sanctioned by DELAWARE INTERSCHOLASTIC ATHLETIC ASSOCIATION and held at (place) _________________

_______________________________________________ on (date) ___________________________________________

Full name of competitor for whom record is claimed (give all four names if a relay team)

_______________________________________________________ Date of Birth ________________________________

_______________________________________________________ Date of Birth ________________________________

_______________________________________________________ Date of Birth ________________________________

_______________________________________________________ Date of Birth ________________________________

This competitor(s) an is an eligible member of the _______________________________ High School, said high
school being a qualified member of the DELAWARE INTERSCHOLASTIC ATHLETIC ASSOCIATION under whose
rules the school competed. The Claimed record was (time, height or distance) ______________________________
Was the record established in competition limited exclusively to high school contestants? _____ How many high
schools were represented in the meet? ______

ENDORSEMENT BY EXECUTIVE DIRECTOR OF DELAWARE INTERSCHOLASTIC ATHLETIC ASSOCIATION
The foregoing track and field meet was sanctioned by DELAWARE INTERSCHOLASTIC ATHLETIC ASSOCIATION and conducted in compliances with the National Alliance Rules.  
                                                                          Executive Director ______________________________________ , DIAA

STATEMENT OF REFEREE I am acquainted with the officials who have attached their signatures to this application. I believe they are competent and that they acted conscientiously and in good faith. The conditions were official in every way. An anemometer or anemometers, as prescribed by rule, was used and there was no tail wind (for sprints, hurdles, long jump or triple jump) exceeding 4.473 miles per hour.  I cordially recommend the claim to the State Interscholastic Records Committee for Delaware State Record.

Anemometer reading (actual M.P.H.) __________ Weather _______________ T & F condition _________________