Needham Youth Hockey Association
COACHING APPLICATION
(Please print)

CONTACT INFORMATION
NAME: _____________________________________________________________________________________ ADDRESS: __________________________________________________________________________________
E-MAIL: _____________________________________________________________________________________ PHONE: (home) ___________________________________ (work) ______________________________________ SOCIAL SECURITY NUMBER__________________________________________________________________ (Requested for USA Hockey membership)

COACHING INTERESTS
TEAM COACH: INTR _____ MT_____ SQ _____ PW _____BN _____MG _____ HEAD / ASST____________

AGE GROUP COACHING COORDINATOR: YES _____ LEVEL (S) __________________________________

NYH SKILLS DEVELOPMENT INSTRUCTOR: YES _____ LEVEL (S) ________________________________

HOCKEY / COACHING EXPERIENCE

CURRENT USA HOCKEY CEP PATCHING LEVEL:
Masters Advanced Intermediate Associate Initiation
(Please provide a photocopy of the front and back of your USA Hockey CEP card.)

COACHING EXPERIENCE WITH NYH: _______________________________________________________________________ (year / team / head or assistant) _____________________________________________________________________________________________

OTHER COACHING EXPERIENCE: ________________________________________________________________________

HOCKEY PLAYING EXPERIENCE (youth, high school, college, etc.): ___________________________________________________________________________________

OTHER COACHING COMMITMENTS FOR THIS SEASON: _______________________________________

(Note: Mass Hockey requires all coaching candidates to complete a CORI form as part of a background check for criminal activities, including physical and sexual abuse. This form must be completed and submitted with this application.)

Agreement: I have read or will read the USA Hockey and Mass Hockey publications on coaching ethics and understand that behavior contrary to these guidelines will be grounds for dismissal from NYHA coaching. I also understand that if I am selected as Head Coach of a NYHA Travel Team that I will make that team my primary coaching responsibility.

________________________________ ______________________________

SIGNATURE   DATE

Please mail completed forms to: NYHA,attn: Al Pace, PO Box 98028, Needham, MA 02492