USA Volleyball RVA Junior Volleyball Coaching Application Form

(mail to Team Yakima, P O Box 8343, Yakima, WA 98908)

(questions--call Mike Hargrave 509-930-6877)

NAME:_____________________________PHONE(h)____________E-MAIL________________

ADDRESS________________________________PHONE(w)____________FAX______________

WORK ADDRESS_____________________________________SOC SEC#__________________

CITY_________________________STATE____ZIP_______BIRTHDATE______________

Height_____Weight_____Shoe Size____Shirt Size_____

Car Make________Style_______Color______State/Plate#_________Capacity w/belts_____

Car Insurance Co_______________________________Time/Days you could coach_____________

GENERAL EDUC: degree________, college________________________, major ______________

PREVIOUS VB COACHING EXPERIENCE (when/division/position/season record)

WHAT OTHER SPORTS HAVE YOU COACHED SERIOUSLY?

PREVIOUS VB PLAYING EXPERIENCE (when/division/awards & record)

LIST ANY VB/SPORT CLINICS ATTENDED (when/sport/place/instructor/hours/name)

PROVIDE REFERENCE INFORMATION

PERSONAL REFERENCE:                            PROFESSIONAL REFERENCE:

Name______________________                   Name_______________________

Address____________________                    Address_____________________

City/State/Zip________________                    City/State/Zip________________

Phone(____)________________                     Phone(_____)________________

Name______________________                   Name_______________________

Address____________________                    Address_____________________

City/State/Zip________________                    City/State/Zip________________

Phone(____)________________                     Phone(_____)________________