2022-2023 STS New Head Coaching Application

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Please complete this form accurately and completely if you are interested in coaching for the 2022-2023 season by February 15, 2022.

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Email Address *

Phone Contact # *

What division are you applying for? *

Mini Mite 6U

Mite 8U

Squirt

Pee Wee

Bantam

Midget

Girls 8U

Girls 10u

Girls 12U

Girls 14U

Girls 16U

Girls 18U

Other:

Level of Play *

MOHL

Travel-Major

Travel-Minor

Travel-Mixed

Have you completed a background screening in the past 2 years? *

Yes

What is your CEP #

CEP Level *

Level 1

Level 2

Level 3

Level 4

I do not have CEP certification at this time.

Which USAH coaching modules have you completed? *

10U

12U

14U

16/18U

Girls Specific Chapters

Required

Please list your proposed assistant coach/es:

Do you have a child/ren in the age/division you are applying for? *

Yes

Previous Coaching Experience: (Please list year/s, association, division, level and position held.)

Have you ever been arrested? *

Yes

If yes, please list date, place and reason:

Have you ever been charged with any crime other than speeding? *

Yes

If yes, please list date, place and reason:

Have you ever been convicted of any crime other than speeding? *

Yes

If yes, please list date, place and reason:

Have you been adjudged liable for civil penalties or damages involving sexual or physical abuse of children? *

Yes

if yes, please explain:

Have you ever been subject to any court order involving any sexual or physical abuse of a minor, including but not limited to domestic order for protection? *

Yes

if yes, please explain:

Have you ever been terminated, resigned, or asked to resign from a position, whether paid or unpaid, due to complaints of sexual or physical abuse of a minor? *

Yes

if yes, please explain:

Do you have a history of other behavior that indicates you may not be an appropriate candidate to work with children in the STSAHA programs? *

Yes

if yes, please explain:

Have you ever received a major misconduct penalty where you as a coach were required to appear before as hockey hearing of some type? *

Yes

if yes, please explain:

Have you every been subject to any disciplinary proceedings as a member of any hockey association or been requested to leave an association? *

Yes

if yes, please explain:

Please add any other information that you would like to share with the Board of Directors to consider regarding your coaching application. This should include your coaching philosophy, short term goals, long term goals and any other information you feel is important in helping us to make this decision.

Reference #1 - First & last Name *

Reference #1 - Phone Contact Number *

Reference #1 - Relationship to you *

Reference #2 - First & last Name *

Reference #2 - Phone Contact Number *

Reference #2 - Relationship to you *

Reference #3 - First & last Name *

Reference #3 - Phone Contact Number *

Reference #3 - Relationship to you *

Please read carefully before signing & submitting:

As a Head coach I will familiarize myself with and attempt to at all times adhere to the “USA Hockey Coaches Code of Conduct.” I will also ensure that all members of my staff, including myself, will be compliant with required coaching levels and modules established by USA Hockey and STSAHA.

As a Head Coach of a STSAHA team, I will be responsible for conducting myself as a positive role model for those players selected or drafted to the team I am assigned to coach. As a role model and positive influence, I will accept responsibility for not only my behavior and conduct but also the conduct of my assistant coaches, managers, players and parents.

I further understand that all STSAHA Head Coaches are appointed by the STSAHA Board Members and that Head Coach Positions are at all times, “at will.” I further understand that this is a volunteer position and that I will not receive monetary compensation or any other remuneration or fringe benefit for serving in this position.

I also acknowledge that inappropriate behavior of the coach or members of his or her staff could result in disciplinary action by the STSAHA Board Members who have the authority to remove the Head Coach, Assistant Coaches and Manger at any time if it is determine to be in the best interest of the STSAHA and its members.

I certify that all the information I have provided is true and accurate to the best of my knowledge. I also understand that providing false or inaccurate information in this application will disqualify me from further consideration as a coaching staff candidate or will result in my immediate dismissal if named to a coaching position.

By submitting my electronic signature below, I authorize the STSAHA to investigate all information regarding my background in considering of this application. I hereby waive, release and forever discharge the STSAHA, its officers, directors and members from any liability for damages that may result from compliance with this authorization. If you agree please type your full first and last name below. *

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