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Applicant Information
Last Name
First Name
Phone Number
Email Address
Street address
City
Mississauga
Brampton
Burlington
Caledon
Georgetwon
Guelph
Hamilton
Milton
Oakville
Toronto
Vaughan
Other
Postal Code
Desired Coaching Position:
Age
Level
1st Choice
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
Minor Atom '02
Atom '01
Minor Peewee '00
Peewee '99
Minor Bantam '98
Bantam'97
Minor Midget '96
Midget Junior '95
Midget Senior '94
Any
A
Any
2nd Choice
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
Minor Atom '02
Atom '01
Minor Peewee '00
Peewee '99
Minor Bantam '98
Bantam'97
Minor Midget '96
Midget Junior '95
Midget Senior '94
Any
A
Any
3rd Choice
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
Minor Atom '02
Atom '01
Minor Peewee '00
Peewee '99
Minor Bantam '98
Bantam'97
Minor Midget '96
Midget Junior '95
Midget Senior '94
Any
A
Any
Preferences:
Coach related child only?
Yes
No
If "Yes", what is his/her
current age and level?
IP 4 year old
Initiation Program
Minor Novice
Novice
Minor Atom
Atom
Minor Peewee
Peewee
Minor Bantam
Bantam
Minor Midget
Midget
Midget Junior
Midget Senior
Juvenile
Other
AAA
AA
A
Red
Red/White (MN)
White
Blue
Green
IP
Type in Level
Qualifications:
Certification
Year Obtained
Number (if applicable)
Certification 1
Initiation Program
CBET Coach Level
CBET Development 1
CBET Development 2
CBET Advanced
NCCP Coach
NCCP Intermediate
NCCP Advanced
Trainers I
Trainers II
None
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Prior to 1980
Certification 2
Initiation Program
CBET Coach Level
CBET Development 1
CBET Development 2
CBET Advanced
NCCP Coach
NCCP Intermediate
NCCP Advanced
Trainers I
Trainers II
None
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Prior to 1980
Certification 3
Initiation Program
CBET Coach Level
CBET Development 1
CBET Development 2
CBET Advanced
NCCP Coach
NCCP Intermediate
NCCP Advanced
Trainers I
Trainers II
None
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Prior to 1980
Certification 4
Initiation Program
CBET Coach Level
CBET Development 1
CBET Development 2
CBET Advanced
NCCP Coach
NCCP Intermediate
NCCP Advanced
Trainers I
Trainers II
None
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
Prior to 1980
Speak Out?
Police Check Done?
Experience:
Total years of experience, including those listed below
0
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
>20 years
Indicate your last 5 years experience working with children, starting with the most recent:
Organization
Age
Level
Position
Season
Erindale
Applewood
Clarkson
Cooksville
Credit Valley
Lorne Park
Meadowvale
Port Credit
Braves
Hornets (Ice Warriors)
Humber Valley
Humberview
Jets
North Stars
Terriers
Rebels
Senators
Oakville
Brampton
Other
IP 4 year old
Initiation Program
Minor Novice
Novice
Minor Atom
Atom
Minor Peewee
Peewee
Minor Bantam
Bantam
Minor Midget
Midget
Midget Junior
Midget Senior
Juvenile
Other
AAA
AA
A
Red
Red/White (MN)
White
Blue
Green
IP
Type in Level
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
10-11
09-10
08-09
07-08
06-07
05-06
04-05
03-04
Prior to 03
Erindale
Applewood
Clarkson
Cooksville
Credit Valley
Lorne Park
Meadowvale
Port Credit
Braves
Hornets (Ice Warriors)
Humber Valley
Humberview
Jets
North Stars
Terriers
Rebels
Senators
Oakville
Brampton
Other
IP 4 year old
Initiation Program
Minor Novice
Novice
Minor Atom
Atom
Minor Peewee
Peewee
Minor Bantam
Bantam
Minor Midget
Midget
Midget Junior
Midget Senior
Juvenile
Other
AAA
AA
A
Red
Red/White (MN)
White
Blue
Green
IP
Type in Level
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
10-11
09-10
08-09
07-08
06-07
05-06
04-05
03-04
Prior to 03
Erindale
Applewood
Clarkson
Cooksville
Credit Valley
Lorne Park
Meadowvale
Port Credit
Braves
Hornets (Ice Warriors)
Humber Valley
Humberview
Jets
North Stars
Terriers
Rebels
Senators
Oakville
Brampton
Other
IP 4 year old
Initiation Program
Minor Novice
Novice
Minor Atom
Atom
Minor Peewee
Peewee
Minor Bantam
Bantam
Minor Midget
Midget
Midget Junior
Midget Senior
Juvenile
Other
AAA
AA
A
Red
Red/White (MN)
White
Blue
Green
IP
Type in Level
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
10-11
09-10
08-09
07-08
06-07
05-06
04-05
03-04
Prior to 03
Erindale
Applewood
Clarkson
Cooksville
Credit Valley
Lorne Park
Meadowvale
Port Credit
Braves
Hornets (Ice Warriors)
Humber Valley
Humberview
Jets
North Stars
Terriers
Rebels
Senators
Oakville
Brampton
Other
IP 4 year old
Initiation Program
Minor Novice
Novice
Minor Atom
Atom
Minor Peewee
Peewee
Minor Bantam
Bantam
Minor Midget
Midget
Midget Junior
Midget Senior
Juvenile
Other
AAA
AA
A
Red
Red/White (MN)
White
Blue
Green
IP
Type in Level
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
10-11
09-10
08-09
07-08
06-07
05-06
04-05
03-04
Prior to 03
Erindale
Applewood
Clarkson
Cooksville
Credit Valley
Lorne Park
Meadowvale
Port Credit
Braves
Hornets (Ice Warriors)
Humber Valley
Humberview
Jets
North Stars
Terriers
Rebels
Senators
Oakville
Brampton
Other
IP 4 year old
Initiation Program
Minor Novice
Novice
Minor Atom
Atom
Minor Peewee
Peewee
Minor Bantam
Bantam
Minor Midget
Midget
Midget Junior
Midget Senior
Juvenile
Other
AAA
AA
A
Red
Red/White (MN)
White
Blue
Green
IP
Type in Level
Head Coach
Asst Coach
Trainer
Manager
IP Instructor
Group Instructor
Volunteer
10-11
09-10
08-09
07-08
06-07
05-06
04-05
03-04
Prior to 03
Coaching Philosophy/Other Notes to Selection Committee:
Please note minimum volunteer requirements include Speak Out training and Police Check. In addition, coach positions require additional certification, depending on age and level. See chart online. Trainers need Trainer I certification as a minimum, but Trainer II is preferable.
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