Girl Action Team Coach Volunteer Application
Name
Address
City
Home Phone (
Cell Phone (
)
)
Zip
Work Phone (
)
Email
Best Way to Contact You
Date of Birth
Workplace (Optional)
Job Title
*
*This item is used for GFC records only.
COACH MATCHING When matching applicant coaches with partner coaches and girl teams, we take in to
consideration your preferred availability and location. Please fill out the information below as thoroughly as
possible:
Location Teams generally meet at a school site. Please let us know areas where you can coach a team:
Please specify:
West Phoenix
South Phoenix
East Phoenix
Central Phoenix
Availability Teams meet at a variety of times throughout the week. The majority of teams need to meet
immediately after school due to transportation issues. If your workplace allows flexibility during the work
day, we can assign a team closer to your work place. Please check all that apply below:
Weekday Afternoons (meetings start b/t 2:30 p.m. and 4 p.m.) (Days you are NOT available
)
I prefer to have a team near my workplace in:
(please be as specific as possible here, include an
address if possible)
I prefer to have a team near my home
Season: Teams meet for 12 weeks. There will be two rounds of teams. Round one in the fall and round two in
the spring. Please check which season you would like to coach.
Fall: August 2011 to December 2011
Spring: January 2012 to April 2012
I have no strong preference to season. I will coach either in the fall or the spring
I would like to coach the fall and the spring
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
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Do you have a preference for working with:
Middle School
High School
Either
Do you have a preference for working with youth from a specific school, socio-economic,
ethnic or sexual orientation group? No Yes If yes, please specify:
Do you have a friend or co-worker applying that you would like to co-coach with?
No
Yes If yes, please write her name here:
Please describe here any experience working with youth (tutoring, parenting, etc). This is not
required to be a coach.
BACKGROUND CHECK
In compliance with state law, GFC conducts background checks, including references and criminal
background, on all coaches to insure the safety of coaches and girls in our program. In order to cover the
cost of background checks, GFC charges $15 to all coaches. (Financial assistance is available). Please
indicate how you would like to cover the fee and then answer the two questions that follow:
Check Included (Make check payable to GFC)
I’ll pay at coach orientation
I can pay $
and want financial assistance for the rest
I am requesting financial assistance for $15
1. Have you ever been convicted of a crime? Yes
No
If yes, please state the offenses, date and location
(A child abuse/neglect conviction status or status as a registered sex offender is cause for automatic
disqualification. Other convictions will not necessarily be cause for disqualification.)
2. Is there a fact or circumstance involving your background that would call into question you being
entrusted with the supervision, guidance and care of youth or money? )
Yes
No
If yes, please explain
(A registered sex offender living in your household is cause for automatic disqualification.)
FINGERPRINTING
Each coach is required to be fingerprinted before starting with a team. Coaches must be fingerprinted for
GFC. If you have a current AZ fingerprinting card, we will need a copy. We will send qualified coaches
materials regarding fingerprinting. The cost of fingerprinting varies depending on the agency. (Financial
assistance is available). YOU MUST BE FINGERPRINTEDBEFORE YOU BEGIN COACHING. Initial here
to indicate you read this statement and agree to be fingerprinted:
REFERENCES You must have a mailing address for each reference. References are mailed a one page
reference sheet. Include someone who knows your skills and abilities working with youth and at least one
person who has known you for 2 years.
Reference #1
Reference #2
Reference #3
Name
Street Address
(Required for each)
City, State, Zip
(Required for each)
Phone Number and
Email
REFERRAL SOURCE Where did you hear about GFC?
ETHNICITY – Check All that Apply (Optional)
African-American or Black
Asian or Asian-American (Indian, Japanese, Chinese, Korean, Filipino, Vietnamese, other)
Caucasian or White
Latina or Chicana
Native American Indian or Alaska Native
Native Hawaiian or other Pacific Islander (Native Hawaiian, Guamanian, Chamorro, Samoan, other)
Multi-racial (please expand if you would like to):
RELEASE I hereby apply to be a coach with GFC and agree to all requirements for coaching stated in this
application. I consent that Girls For A Change may use videotapes, photographs, motion pictures, electronic
images and/or audio recordings in which I appear for public relations and publicity purposes. I certify that all
information provided on this application is true and complete. I understand that falsification or significant
omissions of any information may be considered justifications for dismissal if discovered at a later date. I
authorize the release of information requested from references.
Agree Disagree
Initials (if submitting by email) OR Signature
Date
SUBMIT You can email this application.
 Email: [email protected]
Attn: Girls For A Change
www.girlsforachange.org/