Youth Travel Coaching Application

Youth Travel Coaching Application
Personal Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number *

PRIOR COACHING EXPERIENCE (list the most recent first) If you are a returning LAHA coach - enter the word "Returning" and leave section blank Team Level/ Head or Club / Organization Asst.*

	Years	Club/Organization	Team Level	Position
Experience 1
Experience 2
Experience 3

USA HOCKEY COACHING CERTIFICATION LEVEL
Coaching Card Number*
CEP Number
Coaching Certification Level*
Level
Year Obtained*
Year
Date Safe Sport Certification Obtained?*

MonthDayYear
Date
Date Background Screening Obtained?*

MonthDayYear
Date
Online Modules Completed? (check all that apply)*

Mite (8U)Squirt (10U)PeeWee (12U)Bantam (14U)Midget (18U)
PLAYING BACKGROUND
Did you play any of the following? (check all that apply)*

Youth HockeyHigh School HockeyJunior HockeyCollege HockeyOther
PLAYERS IN THE ASSOCIATION
Mark which level(s) you have players participating in at LAHA:*

Learn to SkateLearn to PlayMini-MiteMiteSquirtPeeWeeBantamHigh School
TEAM CHOICE
What role are you interested in?*

Head CoachAssistant CoachPractice Only CoachGoalie Coach

Rank your choice of teams you would like to be involved with.*

	Rank
1st Choice
2nd Choice
Rank 3

REFERENCES (List three people not related to you – not required for returning coaches)*

	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?*
What would your goals be for the team that you want to coach?*
Upload resume or other pertinent information

Cancelof
In-person interviews will be given by the Hockey Director.*

I understand
Completion of this application form does not guarantee you acceptance for a position with LAHA. Offer of a coaching position is also subject to the results of a background check along with satisfying the necessary requirements of USA Hockey.*

I understand
By signing below, I certify all information is true and correct.*

I understand
Signature*

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Youth Travel Coaching Application

Personal Information

USA HOCKEY COACHING CERTIFICATION LEVEL

PLAYING BACKGROUND

PLAYERS IN THE ASSOCIATION

TEAM CHOICE