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
Format: (000) 000-0000.

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.

Rows	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)
PLAYING BACKGROUND
Did you play any of the following? (check all that apply)

Other
PLAYERS IN THE ASSOCIATION
Mark which level(s) you have players participating in at LAHA:
TEAM CHOICE
What role are you interested in?

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

Rows	Rank
1st Choice
2nd Choice
Rank 3

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

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?
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.
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.
By signing below, I certify all information is true and correct.
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Youth Travel Coaching Application

Personal Information

USA HOCKEY COACHING CERTIFICATION LEVEL

PLAYING BACKGROUND

PLAYERS IN THE ASSOCIATION

TEAM CHOICE