Risk Management Application (RMA) number (log into your Affinity account to view)
Your answer
RMA Expiration Date
MM
/
DD
/
YYYY
Are you currently coaching? *
If Yes, name of Association and Club
Your answer
Years of Coaching Experience
Your answer
How many teams do you plan to coach this upcoming season?
Clear selection
Are you certified to ref?
Clear selection
If yes, what is your grade?
Clear selection
Coaching Experience: describe coaching positions, starting with the most recent. Include dates, gender, age, level of play (recreational or competitive), club/association, and your position (head coach, assistant coach, trainer). (You can send Coach Bio/Resume to hsaselect@gmail.com to meet this requirement.)
Your answer
Describe your soccer training and playing experience. (You can send Coach Bio/Resume to hsaselect@gmail.com to meet this requirement.)
Your answer
Please list all coaching clinics, seminars and classes attended. (You can send Coach Bio/Resume to hsaselect@gmail.com to meet this requirement.)
Your answer
List any special achievements or awards. (You can send Coach Bio/Resume to hsaselect@gmail.com to meet this requirement.)
Your answer
REFERENCES – list references (up to 3) who are willing to provide information on your coaching ability. List name and phone number.
Your answer
Have you ever been terminated from or been asked to resign your position with a youth organization? *
If Yes, please explain.
Your answer
Have you ever been subject to disciplinary action, placed on probation or suspended by a youth organization because of disciplinary action? *