Mt. Lebanon Basketball Association (MLBA) | COACH APPLICATION FORM
ALL VOLUNTEER COACHES MUST COMPLETE THIS APPLICATION AND COMPLY WITH ALL REQUIREMENTS NOTED WITHIN IN ORDER TO BE CONSIDERED FOR ANY VOLUNTEER COACHING POSITION WITH THE MLBA.
Email address *
Name *
First and Last Name
Your answer
Address *
Your answer
Email *
Your answer
Phone Number (mobile) *
Your answer
Phone Number (home) *
Your answer
Coaching Position(s) Desired *
Required
Gender/Grade Level Coaching Preference *
Select your preference to Coach a Girls or Boys team... and Grade Level.
Required
Have you CREATED A USER ACCOUNT and REGISTERED AS A VOLUNTEER on our website? (http://www.mtlebanonbasketball.com) *
Required
State your reason for applying as a VOLUNTEER BASKETBALL COACH *
Your answer
EXPERIENCE: Coaching Education (1) *
Select any of the following that have informed your Coaching experience.
Required
EXPERIENCE: Coaching Education (2) *
Explain your choices as selected above.
Your answer
EXPERIENCE: Instructional Leadership of Children (explain): *
Your answer
EXPERIENCE: Previous Coaching Experience *
LIST: Sport / Level / Gender / Grade / Year / Agency
Your answer
Certifications *
List all Coaching certifications you have earned and year earned.
Your answer
Concussion Training *
Have you completed the CDC's Concussion Training? (https://www.cdc.gov/headsup/youthsports/training/index.html)
Required
Month/Year CDC Concussion Training Completed? *
Your answer
CPR Certification *
Are you CPR certified?
Required
First Aid Certification *
Are you First Aid certified?
Required
Pennsylvania Child Protection Law Clearances *
***** PLEASE CHECK ALL CERTIFICATIONS YOU HAVE COMPLETED ***** PA Child Protection Laws require background checks for all of our coaches. If not already obtained, you MUST comply with these requirements as listed below and provide a current copy of each clearance to the MLBA prior to being confirmed as a Coach. (*) = For those who have been PA residents for 10 years or MORE, a signed Affidavit of Compliance is required. (**) = For those who have been PA residents for LESS than 10 years, an FBI Background Check is required. (Having both is not required; only 1 is required as applicable.) ***** PLEASE CHECK ALL CERTIFICATIONS YOU HAVE COMPLETED.
Required
Thank you for your time!
A copy of your responses will be emailed to the address you provided.
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