NASHUA BLAST YOUTH LACROSSE COACHING APPLICATION

NASHUA BLAST YOUTH LACROSSE COACHING APPLICATION

NAME: _________________________________________ MOBILE: ______________________ ADDRESS: _____________________________________________________________________ EMAIL: _______________________________________________________________________ CURRENT USL MEMBERSHIP # AND EXPIRATION: ________________________EXP: ________ USL COACHING CERTIFICATIONS (if have) :

LEVEL 1 ___________ LEVEL II ______________ DATE

DATE

PLEASE INCLUDE A COPY OF YOUR CERTIFICATION OR INDICATE HERE THE DATE YOU ARE SCHEDULED TO ATTEND THE COACHES CLINIC IN PERSON OR ONLINE: ___________________ DO YOU HAVE CHILDREN IN THE PROGRAM: Y / N IF YES PLEASE INDICATE WHAT LEVEL(S) THEY WILL PLAY FOR: __________________________ ______________________________________________________________________________ WHAT LEVEL ARE YOU INTERESTED IN COACHING? ( indicate order of preference with 1, 2, 3…) 7U _______

Boys

10U _______ B / G

13U _____

B /G

8U _______

B /G

11U _______ B / G

14U _____

B /G

9U _______

B /G

12U _______ B / G

15U _____

B /G

COACHING EXPERIENCE (please include lacrosse and non-lacrosse): ______________________ ______________________________________________________________________________ ______________________________________________________________________________

PLEASE INDICATE ANY LACROSSE PLAYING EXPERIENCE YOU PERSONALLY HAVE: __________ ______________________________________________________________________________ ______________________________________________________________________________ PLEASE DESCRIBE WHY YOU WOULD LIKE TO COACH FOR NASHUA BLAST: ________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________

FOR ORGANIZATION USE ONLY: INTERVIEW DATE: ________________________ BOARD VOTE FOR: _______AGAINST: ______ POSITION AWARDED: ___________________________________________________________ CODE OF CONDUCT DATE SIGNED: _________________________________________________ USL COACHING CERTIFICATION: clinic / online LEVEL 1 __________ LEVEL II ____________ DATE

DATE

USL MEMBERSHIP # AND EXPIRATION: ________________________________ EXP: ________ BOARD VERIFICATION BY: _______________________________ POSITION: _______________