Application to Coach

By submitting this Application to Coach, I am certifying to Massachusetts Youth Soccer that all of the information contained in this Application is true and correct. I am also certifying that, in accordance with state law, I have submitted or will submit my Adult Registration to Massachusetts Youth Soccer and for a criminal background check (CORI). I will also complete Safe Sport Abuse & Prevention training and US Soccer Recognize to Recover concussion training, once a year.

Please note, all Coaches selected for the District Select Program will be required to submit a W9 form, confirming eligibility to receive the DSP Coach auto stipend.

Coach Position Sought

I am applying for a coaching position in the Massachusetts Youth Soccer... *

District Select Program

Are you a W2 employee of Mass Youth Soccer? *

Yes

No

What programs do you work with in Mass Youth Soccer? *

I would prefer to coach players of the following gender. *

I would prefer to coach a team in the following age group. *

Personal Information

First Name *

Last Name *

Street Address *

City *

State *

Zip Code *

Phone Number *

Email Address *

Coaching Education

The Highest Level United Soccer Coaches Diploma I have Attained is *

The Highest Level USSF Coaching License I have Attained is *

Required for those applying to Coach in the District Select Program.

Select the District in which you want to coach.

Coaching Experience

Present Coaching Position(s)

Club or Organization *

Gender *

Age Group *

Club or Organization Contact *

Club Contact's Email *

Club or Organization

Gender

Age Group

Club or Organization Contact

Club Contact's Email

Prior Coaching Positions

Please include Club or Organization, Gender and Age Group of Team, Years Coached and Club or Organization Contact Information. Type in None if no further information is provided. *

Playing Experience

College Team

Years

Club Team

Years

Other Teams (Include Team and Years)

Resume (Optional)

Attach Copy of your Resume (Optional)

Mission Statement (Optional)

What is your personal coaching mission statement?

References

Please indicate the name and email address of two (2) references.

Reference Full Name *

Reference E-mail Address *

Reference Full Name *

Reference E-mail Address *

Coach Certification *

I certify the information contained herein is true and accurate.