Host a Community Coaching Course Application Form

Host a Community Coaching Course Application Form
Club Name*
Club Contact / Course Coordinator Name*
This should preferably be the Club Coach Coordinator (CCC)
Contact Email*
Contact Number*
Proposed Course*

MiniRoos Certificate (4-8 years)Foundation of Football (C Diploma Part 1)Game Leader (junior referees)Grassroots CPD Workshop: Supporting Your Grassroots Coaches to InspireGrassroots CPD Workshop: Intervention Methods for Grassroots CoachesGrassroots CPD Workshop: Developing A Love For The Ball - Ball Mastery
Proposed Venue Name*
Proposed Venue Address*
Please include Street Address, Suburb and Post Code.
Preferred Start Date(s) and Times*

DayMonthYearHourMinutesAM/PM Option
For Foundation of Football course, please provide here additional dates should you wish to provide a flexible delivery model (e.g., split 9-hour F2F component into separate days)blank
Alternate Start Date(s) and Times*

DayMonthYearHourMinutesAM/PM Option
Number of your club coaches attending*
For a course to go ahead there must be a minimum of 10 confirmed attending coaches - where support is required to achieve these minimum participation numbers the MFA Football Development Manager can provide support via promotion to other local clubs.
Our club can provide the following equipment (if required):

Balls (20 minimum)2 sets of different coloured Bibs2 full sets of Cones (4 different colours)Goals (suitably aged to course delivery)Players (suitably aged to course delivery)
Our club will make the following pitch space available:*

1/8 pitch (minimum for MiniRoos and Game Leader)1/4 pitch1/2 pitch (minimum required for FOF)
Our club can provide these facilities:*

Meeting room/ clubroom (with chairs and tables)Audio / visual equipment (e.g. projector or screen for presenting content)Visual equipment (e.g. whiteboard w/ presentation stand)Male and Female change rooms and toiletsRefreshments for participants (e.g. tea, coffee, water or open canteen)None of the aboveOther
Additional comments:
Feel free to provide any further information (e.g. your long term coach development plan at the club) or ask any questions here.
Please note that submission of this form does not guarantee a course will be scheduled. After submitting the form, the Football Development Manager will be in contact within 48 hours to confirm and discuss further.
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