AYSO Region 630 EXTRA Play Fall 2024 Program Head Coach Application Form
This is an application for Head Coach only.  The Head Coach and Extra Play Program Manager will coordinate to select the Assistant Coach.

Submission of this application is not a guarantee that you will coach an EXTRA Play team.  Region 630 EXTRA Play Coaches are approved and appointed by the EPP Coach Selection Committee.  All qualified applicants and the applicant's child/player will be observed prior to coaching selection to ensure that both meet EXTRA Play caliber as a coach and player.
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Email *
Requirements for Eligibility  Untitled Title
To be eligible, you must:
  • Fill out and submit this form COMPLETELY by no later than the deadline of DECEMBER 1, 2023
ALL applicants must have, at a minimum, the following certifications to be eligible*:
  • Risk Status Verified
  • Concussion Awareness
  • LiveScan Fingerprinted
  • Sudden Cardiac Arrest
  • Safe-Haven
  • Safe Sport
  • Referee Certified (Regional/Basic minimum)
ALL applicants must also have the appropriate coaching certification by division*:
  • 09U and 10U: 10U Certification
  • 11U and 12U: 12U Certification
  • 13U and 14U: Intermediate Certification
*Certifications should be obtained prior to start of spring season.
Applicant Name (First and Last)
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Division Applying For:
Clear selection
Address
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Phone number
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Child's Name
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Certifications Held:  Your certifications are listed on the Volunteer tab at ayso630.org
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Required
Other Coaching Certifications/Experience
In 2-3 sentences, tell us why you would make a good EXTRA coach?
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Any other comments
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