SMHA COACH APPLICATION FORM

2010-2011

APPLICANT INFORMATION

 Name :                                        

             Mailing Address :                                          

Postal Code :                                                                                

Home Phone :           Work Phone :                      

Cell Phone :           Fax :                                        

Email Address :                               

Date of Birth :                                                   

Place of Birth :                                                 

Employer :                                        

Occupation :                                     

Employer Address :                        

Employer Phone :                                                                      

PREFERRED COACHING ASSIGNMENT

Squirts                 

Initiation A           

Initiation B           

Initiation C           

Atom House        

Atom Dev            

Pee Wee House 

Pee Wee Rep     

Bantam House    

Bantam Rep        

Midget House      

Midget Female    

Midget Rep          

Comments (500 character max)

CERTIFICATION / TRAINING

Please indicate year of completion and location

NCCP Theory 1                                             

NCCP Theory 2                                             

Initiation Program                                            

Coach Level or Coach Stream                        

Intermediate Level or Developmental 1           

Advanced Level 1 or 2                                    

CSP                                                               

Speak Out                                                      

Checking Clinic                                               

Coaching Association of Canada Passport #   

Comments (500 character max)

HOCKEY COACHING EXPERIENCE

List in order of most recent

Year -  Association and Team Name -  Age Group - Position

1 .

2. 

3. 

4. 

5. 

OTHER SPORTS COACHING EXPERIENCE

List in order of most recent

Year -  Association and Team Name -  Age Group - Position

1. 

2. 

3. 

PLAYING EXPERIENCE

List in order of most recent

Year -  Association and Team Name -  Age Group - Position

1. 

2. 

3. 

4. 

5. 

COACHING REFERENCES

Reference #1

Name :    

Address :   

Phone :    

Position :  

Reference #2

Name :    

Address :   

Phone :    

Position :  

Reference #3

Name :    

Address :   

Phone :    

Position :  

BRIEFLY DESCRIBE YOUR COACHING PHILOSOPHY  

(1000 character max)

BREIFLY DESCRIBE YOUR SEASONAL PLAN

Please include your goals for the team, your thoughts on rules and discipline

and overall player development philosophy as well as any other pertinent information.

(1000 Character Max)

QUESTIONS

please check appropriate response

         1. Do you have a child registered with

             Summerland Minor Hockey? Yes No

          2. If a Coaching Position were not available in the age group of your choice,

              would you be willing to coach in another division or help out with skill clinics?

             Yes No   (If Yes, which division)

          3. If a Head Coaching Position were not available, would you be

              willing to be an assistant coach? Yes No

          4. Do you feel your child will make the team for which you are

              applying? Yes No

         5. In what portion of the team do you feel your child will rate?

Upper Middle Lower

          6. Will you coach the team if an independent committee does not assess

              your child to make the team? Yes No

         7. Are you certified for the level for which you are applying?

Yes No

         8. If you are not certified at the required level, are you available to take a weekend

              course to attain the required level? Yes No

*** SAMPLE PRACTICE PLANS ***

Please prepare a sample practice that is age appropriate for the team you are applying for.

If you are applying for teams in different age groups, prepare a sample plan for each of the age groups.

Please mail to:

SMHA Coach Coordinator

PO Box 1548

Summerland, BC V0H 1Z0

or email to:

kitch_2@hotmail.com

UNDERTAKING

         1. I hereby consent to disclosure of the above information.

         2. I hereby acknowledge the authority of Hockey Canada, BC Hockey, OMAHA,

              and Summerland Minor Hockey Association and agree to carry out and abide

              by their constitution, bylaws, rules and regulations.

         3. I hereby acknowledge that I have read and understand the coach’s role as outlined

              in the “Coaches Code of Conduct”.

         4. I hereby agree to familiarize myself with the National Coaching Certification

              Program (NCCP) requirements for coaching minor hockey and ensure that I

              maintain the required level of certification.

         5. By way of this application, I give permission to Summerland Minor Hockey Association

to pursue a criminal record search on myself.