SECTION 1: APPLICANT INFORMATION

Today’s Date:

Applicant Name:

Street Address:

City, State & Zip:

Telephone (Home):

Telephone (Work):

Cell Phone:

Email Address:

Driver’s License Number (For Screening):

Current Employer:

SECTION 2: APPLICANT'S SON OR DAUGHTER IN SMAHL

Child's Name:

Team Child Played on Last Season:

Child's Date of Birth:

Child's Playing Position:

SECTION 3: APPLICANT'S COACHING INFORMATION

Desired Position: Head Coach        Assistant Coach        Goalie Coach  

Level: IP             Mini-Mite                 Mini-Mite Dev.       Mite                          Mite All-Star

         Squirt      Squirt All-Star         PeeWee                 PeeWee All-Star     Bantam

Program:  A            AA                B                House

USA Coaching Certificate Level:           Date Received:

Coach's Number:

Other Coaching Certificate:

SECTION 4: APPLICANT'S COACHING EXPERIENCE

Year:       Team:        Coaching Position: Head Coach Assistant Coach Goalie Coach Other

Year:       Team:        Coaching Position: Head Coach Assistant Coach Goalie Coach Other

Year:       Team:        Coaching Position: Head Coach Assistant Coach Goalie Coach Other

SECTION 5: APPLICANT'S PLAYING EXPERIENCE

Year:       Team:        Playing Position:

Year:       Team:        Playing Position:

Year:       Team:        Playing Position:

SECTION 6: REFERENCES (Please give a variety of references, such as parents, other coaches, etc.)

Reference #1 Information:

Name:         Phone Number:         Years Known:

Affiliation:

Reference #2 Information:

Name:         Phone Number:         Years Known:

Affiliation:

Reference #3 Information:

Name:         Phone Number:         Years Known:

Affiliation:

Reference #4 Information:

Name:         Phone Number:         Years Known:

Affiliation:

SECTION 7: COACHING PHILOSOPHY AND APPROACH

Please describe your overall COACHING PHILOSOPHY about playing time, season goals, and discipline.