Representative Team Management Nomination Form
Your Name
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
*
example@example.com
Phone Number
*
-
Area Code
Phone Number
Team
*
Metro League
Opens Team
Under 17's
15 Years
14 Years
13 Years
12 Years
11 Years
Position
*
Coach
Assistant Coach
Manager
Primary Carer
If Team is unavailable who you consider another team?
*
Yes
No
Do you hold the appropriate Coaching Accreditation? Junior & Senior State Title teams Head Coach - Development, Assistant - Foundation. Metro League Div. 1 & 2 Head Coach Intermediate, Assistant Coach - Development. Metro League Div. 3 to 6 Head Coach- Development & Assistant Coach - Foundation.
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Intermediate
Development
Foundation
Do you hold a current working with Children's certificate
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Yes
No
Do you hold a current All Australia Section 1 Umpires Theory Pass?
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Yes
No
Do you hold a current First Aid/Sports Medicine Awareness certificate/or equivalent?
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Yes
No
To be a coach a representative coach at PANA, you will be required to be a member of an affiliated club and cannot have any other representative ties to another association. Are you prepared to join a club within PANA?
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Yes
No
Briefly outline your achievements for the previous 3 years.
*
Use this space to outline your reasons for this application and goals you would like to achieve
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Nominee's Declaration - I understand that I will not be automatically allocated to a team, and that I will have to undergo an interview with a coaching appointment panel. If I am allocated to a team, I will be expected to adhere to the PANA Representative By-Laws and the role of the coach, assistant coach, manager as outlined in the PANA Constitution and By-Laws.
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Submit
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