2017 Pacific Soccer Club Coach Application
Thank you for your interest in Pacific Soccer Club (PSC).

Please complete as much of this application as possible.

Summary of Criteria:
a. Written Approval from your AYSO Regional Commissioner (RC)
b. 3 Years minimum coaching experience
c. AYSO Coach and Safe Haven Certification
d. Player commitments (minimum of 5 players)
e. Professional Trainer
f. Dedicated Team Manager
g. Director of Coaching is to confirm that the team will be competitive in club.

Thank you,

Bruce Bricks, President
Grant Heywood, Director of Coaching
Lee Eichenbaum, Club Administrator

Become Part of the PSC Team
COACH INFORMATION
Coach First Name
Your answer
Coach Last Name
Your answer
Coach Email
Your answer
Coach Primary Phone Number
714-555-1212
Your answer
Coach Secondary Phone Number
Your answer
Coach AYSO ID #
8 Digit Number - we use this to confirm your certifications
Your answer
Coach is AYSO Registered Volunteer?
Check eAYSO for the current year
Risk Management
Check if you are AYSO Safe Haven Certified and/or LiveScan (http://www.calsouth.com/en/risk-management/) ?
Required
Concussion Awareness
Concussion Awareness is required (http://www.calsouth.com/en/safety/)
Required
AYSO Coach Certification
Please check all that apply.
Required
USSF Coach Certification
Please check all that apply. You must have a USSF Licence before the season starts.
Required
Certified Referee
Are you a Trained and Certified Referee?
League
What league are in or just completed?
Other Experience
Number of years and any other experience you consider relevant to your application to coach in PSC (Include AYSO positions held or volunteer tasks performed at the region/area/section level)
Your answer
TEAM INFORMATION
Season
Which season(s) are you applying for?
Area
Region Number
24, 55, 57, 59, 84, ...
Your answer
Region City
Your answer
Division Gender
Current Division Age
What is your team's current Age Division?
Team Birth Year
What will be your oldest player Year of Birth?
Your answer
ASSISTANT COACH INFORMATION
For the protection of both the children and the volunteer, no volunteer should permit himself or herself to be alone with any child or group of children (except his or her own) during AYSO-sponsored activities. The recommended supervision ratio should be 1:8 or less; that is, one adult for every eight or fewer children and two adults present at all times (one of whom may be the coach and one of whom should be the same gender as the players).
Assistant Coach First Name
Your answer
Assistant Coach Last Name
Your answer
Assistant Coach Email
Your answer
Assistant Coach Primary Phone Number
Your answer
Assistant Coach Secondary Phone Number
Your answer
Assistant Coach AYSO ID #
8 Digit Number
Your answer
Assistant Coach is AYSO Registered Volunteer?
Check eAYSO for the current year
Assistant Coach Safe Haven Certified?
Check eAYSO
Assistant Coach Certification
Please check all that apply.
Assistant Coach USSF Certification
Please check all that apply.
Assistant Coach Certified Referee
TEAM MANAGER
The Team Manager is a pivotal part of every team. Team Managers often are the link between the coach and the team families. Typical responsibilities include registration and collecting player fees; player and coach photos, ID cards (passes), referee fees, rosters, game day match reports, inform the parents about uniform orders, schedules, practices, directions, etc. Another important role a Team Parent can play is encouraging spectators to use good language, show good sportsmanship in attitude and behavior, and create an enjoyable experience for everyone. Every PSC team is required to have a dedicated Team Manager
Team Manager First Name
Your answer
Team Manager Last Name
Your answer
Team Manager Email
Your answer
Team Manager Primary Phone Number
Your answer
Team Manager Secondary Phone Number
Your answer
Team Manager AYSO ID Number
8 Digits
Your answer
Team Manager is AYSO Registered Volunteer?
Check eAYSO for the current year
Team Manager Safe Haven Certified?
Check eAYSO for the current year
TEAM ROSTER
Please provide a roster of a minimum of five (5) players and parents that are committed to playing on your PSC team.

First Line: Player Name
Second Line: Parent or Guardian Email

Current League
What league did the Majority of the players participate in?
Current League Finish
What place are you currently in? (1st, 2nd, 3rd, ...)
Current League Flight
Include the flight your team is in.
Player #1
1. Player Name
Your answer
1. Email
Your answer
Player #2
2. Player Name
Your answer
2. Email
Your answer
Player #3
3. Player Name
Your answer
3. Email
Your answer
Player #4
4. Player Name
Your answer
4. Email
Your answer
Player #5
5. Player Name
Your answer
5. Email
Your answer
REFERENCES
Please provide your Regional Commissioners name and email address and at least one other reference in the soccer community.

First Line: Name of Reference
Second Line: Email of Reference
Third Line: Phone Number of Reference

AYSO Regional Commissioner (RC)
1. RC Name
Your answer
1. RC Email
Your answer
1. RC Phone Number
Your answer
Reference #2
2. Reference Name
Your answer
2. Reference Email
Your answer
2. Reference Phone Number
Your answer
Reference #3
3. Reference Name
Your answer
3. Reference Email
Your answer
3. Reference Phone Number
Your answer
AGREEMENTS
AYSO RC Approval
I have written approval from my AYSO Regional Commissioner to coach a PSC team.
AYSO Philosophies
Please indicate that you have read and agree to abide by each of the following AYSO Philosophies.
Required
Team Budget
If accepted I agree to prepare a team budget prior to each season and submit it to PSC for approval.
Good Standing
I am in Good Standing with the following organizations. Select all that apply.
Required
VOLUNTEERS
AYSO is a volunteer-based organization. AYSO remains committed to the belief that volunteers, unified by the vision and mission of AYSO and dedicated to the AYSO philosophies can, and do, deliver a high quality experience for their players and their families. AYSO’s volunteer foundation ensures that it’s all about what’s good for kids.

Volunteers makes AYSO and PSC very affordable. It takes thousands of hours to run a successful region; with registration, team formation, uniform distribution, scheduling, coaching, refereeing, instructing, mentoring, organizing try-outs, field set up and breakdown and playoffs; just to name a few.

PSC parents know the benefits of the AYSO programs. Your parents are among the most knowledgeable and experienced volunteers we have; many are coaches, referees or board members. Encourage them to remain involved with the AYSO Standard Play Programs as instructors, mentors, and board members. It is vital that we retain the knowledge and pass it on to the next generation of passionate AYSO Volunteers.

PSC families are expected to support their Region by volunteering no less than ten (10) hours per family, per year.

Volunteer Requirement
I understand and agree to ensure that my parents support our Region
THANK YOU FOR COMPLETING THIS APPLICATION

Originally posted:
October 18, 2013

Revisions:
Nov 13, 2015 - added concussion awareness and RC approval
17 Nov 16 - updated for 2017 Season
4 Jan 17 - Written Approval from RC

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