Junior Seahawks Youth Hockey Coaching Application
Season
Personal Information
Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Daytime Phone
Format: (000) 000-0000.
Mobile Phone
*
Format: (000) 000-0000.
Evening Phone
Format: (000) 000-0000.
Personal Email
*
example@example.com
Work Email
example@example.com
USA HOCKEY COACHING CERTIFICATION LEVEL
PRIOR COACHING EXPERIENCE (list the most recent first) If you are a returning WSHA coach - enter the word "Returning" and leave section blank Team Level/ Head or Club / Organization Asst.
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Rows
Years
Club/Organization
Reference / Phone #
Team Level
Position
Experience 1
Head Coach
Assistant Coach
Experience 2
Head Coach
Assistant Coach
Experience 3
Head Coach
Assistant Coach
Experience 4
Head Coach
Assistant Coach
Experience 5
Head Coach
Assistant Coach
Coaching Card Number?
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Coaching Certification Level?
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Year Obtained?
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Please Select
2026
2025
2024
2023
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
Date Safe Sport Certification Obtained?
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Background Screening Obtained?
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-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Online Modules Completed? (check all that apply)
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MT
SQ
PW
BT
MD
PLAYING BACKGROUND
Did you play any of the following? (check all that apply)
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Youth Hockey
High School Hockey
College Hockey
Other
List youth hockey organizations where you played.
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List High School(s) where you played.
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List College(s) where you played.
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List other organization(s) where you played.
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TEAM CHOICE
What role are you interested in?
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Head Coach
Assistant Coach
Parent Coach
Non-Parent Coach
Rank your choice of teams you would like to be involved with.
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Rows
Rank
1st Choice
10U Squirts
12U Peewee
14U Bantom
16U Minor Midget
18U Major Midget
Not Interested
2nd Choice
10U Squirts
12U Peewee
14U Bantom
16U Minor Midget
18U Major Midget
Not Interested
3rd Choice
10U Squirts
12U Peewee
14U Bantom
16U Minor Midget
18U Major Midget
Not Interested
4th Choice
10U Squirts
12U Peewee
14U Bantom
16U Minor Midget
18U Major Midget
Not Interested
REFERENCES (List three people not related to you – not required for returning coaches)
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Rows
Name
Relationship
How long
Phone Number
Reference 1
Reference 2
Reference 3
What is your Philosophy of coaching based on the specific age group you are requesting to coach?
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What would your goals be for the team that you want to coach?
Upload resume or other pertinent information
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In-person interviews will be given by the Hockey Director.
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I understand
Completion of this application form does not guarantee you acceptance for a position with WSHA Offer of a coaching position is also subject to the results of a background check along with satisfying the necessary requirements of USA Hockey.
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I understand
By signing below, I certify all information is true and correct.
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I understand
Signature
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