Huron Soccer Association

Form

PERSONAL INFORMATION

1. Date of Application:*

2. Name:*

3. Street Address:*

4. City:*

5. Phone Number:*

6. Present Occupation:*

7. Employer's Name & Address:*

8. Work Phone Number:*

9. Educational Field of Study(College or Above)

10. Ever been convicted of a crime other than traffic violation?*

	Yes
	No

11. Licensed Driver?*

	Yes
	No

12. If "Yes", from what state?

POSITION DESIRED:

13. What age level do you prefer? (U=Under)

	Girls U19
	Girls JV
	Girls U16
	Girls U14
	Girls U12
	Boys U19
	Boys JV
	Boys U16
	Boys U14
	Boys U12
	Any

14. Position:

	Head Coach
	Assistant Coach

15. What specific skill do you have that you will bring to this level of soccer?
(255 char max)

16. Training & Skills:
(255 char max)

17. What is your philosophy with regard to soccer?
(255 char max)

18. List total number of years of soccer experience – Coaching:

19. Highest coaching license obtained:

20. Give your reasons for wanting to volunteer for H.S.A:
(255 char max)

REFERENCES:

List three persons NOT related to you who can judge your qualificaitons for this position:

21. Name:*

22. Phone:*

23. Name:*

24. Phone:*

25. Name:*

26. Phone:*

27. I certify that all the information given on this volunteer application is true and correct. I also give my permission for the verification of the above information by the H.S.A. — if necessary.*

	Yes
	No

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