Coach Application Form
SECTION A – Basic Information
1
Name (surname, given name)
Home Phone
Street Address (include apartment, rural route, etc. as appropriate)
Work Phone
Fax
City/Town
Province
Cell Phone
Postal Code
Primary Email Address
Alternate Email Address
Preferred Coaching Position
1st Choice
2nd Choice
3rd Choice
Age: U
Age: U
Age: U
Male
Female
Male
Female
Male
Do you have a son/daughter playing with Kelowna United Select Soccer?
Female
Yes
No
In order to assist us in planning for future training programs, please answer the following:
I am interested in being assessed/evaluated for the advancement of my coaching skills: Yes
I am interested in pursuing further coaching certification courses or licenses:
Yes
No
No
SECTION B – Coaching Qualifications
N.C.C.P. Number
Fundamentals (month/year)
Provincial “B” License Part 1 BCSA
(month/year)
BCSA Coach Number
Learn to Train (month/year)
National “B” License Part 2 CSA
(month/year)
Soccer for Life (month/year)
Provincial “Pre-B” (month/year)
National “A” License CSA (month/year)
Other relevant qualifications, e.g. international courses/licenses/certifications, etc. (description/month/year)
SECTION C – Previous Coaching Experience
I have coached Kelowna United Select Soccer teams since:
If you have coached teams within the last three (3) years, please provide details in this section.
Year
Year
Year
Year
1
Club
Club
Club
Club
Age
Gender
League/Div
U
Male
Gender
Female
U
Male
Gender
Female
U
Male
Gender
Female
U
Male
Female
Age
Age
Age
League/Div
League/Div
League/Div
Coach Application Form
SECTION D – Personal References – new Select coaches only
Reference #1
Name (surname, given name)
Home Phone
Street Address (include apartment, rural route, etc. as appropriate)
Work Phone
Fax
City/Town
Province
Other Phone (e.g. Cell)
Postal Code
Primary Email Address
Alternate Email Address
Reference #2
Name (surname, given name)
Home Phone
Street Address (include apartment, rural route, etc. as appropriate)
Work Phone
Fax
City/Town
Province
Other Phone (e.g. Cell)
Postal Code
Primary Email Address
Alternate Email Address
SECTION E – Additional Instructions / Information
1. A photocopy of all certificates or any other updated documentation indicating coaching levels attained must be
attached to this application. Do not submit originals, as they will not be returned to you. If you are unable to provide
the required documentation, please provide reasons.
2. A current police records check is a requirement for this position. Procedure for this are available on the KU
website at http://kelownaunited.com/information/formsanddocuments/ A copy of such should be attached to this
application unless it is already on file at the COYSA / Kelowna United Soccer Offices. It is your responsibility to
ensure that an up to date police records check form is provided to the Club.
**** We require an updated Police Records Check every three years (per BC Soccer)
3. Only those coaches shortlisted for a position on a KU Select Team will be contacted and candidates may be
required to attend a personal interview with Club officials.
4. Coaching candidates may be required to conduct a practice session prior to selection to a coaching position.
5. Coaches may be assessed on a periodic basis by the Club Technical Director or his/her designate.
6. Submit this form, along with all required attachments, to the Kelowna United Select Soccer offices at:
#200 – 1415 Hunter Court, Kelowna, BC, V1X 6E6 or email to [email protected]
Applicant Signature
Date
SECTION F – Comments
Provide any additional information or comments you feel are pertinent to your application.
For office use only:
Police Check
Kelowna United Soccer Club
Reference check
Interviews
Coach Application – Page 2
Revised – May 2015