US Lacrosse Women’s Division
High School Coaches Recognition Program
First Name
______________________
Last Name _______________________
USL #
______________________
Exp Date _______________________
(Check One) Active Coach ___
Retired Coach ___
Email Address
__________________________________________________
Street Address
____________________________________________
City, State Zip
____________________________________________
Current High School Name
____________________________________________
Other Varsity Teams Coached
______________________________________
________________________________________________________
________________________________________________________
Years Coaching as Head Coach
___________
Total Varsity Wins – Losses – Ties* ___________ - _____________ - ____________
Other Pertinent Information
_______________________________________
_________________________________________________________
* Coaching records only count if they are from varsity high school teams.
I confirm that all of the above and attached information is accurate.
_____________________________
____________________________
Signature of Coach
Date Submitted
_____________________________
Signature of School Administrator
Along with this form, a copy of the coach’s year-by-year coaching record should be
mailed to Jay Watts, PO Box 250478, Atlanta, GA 30325 or emailed to
[email protected].