Head Coaching Application
Fill out completely & return this application & CORI form by February  1, 2008 (6:00 PM)
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PLEASE PRINT
I.) Name  / Address___________________________________________________________
City  / State /  Phone     ________________________________________________________

II.) USA Hockey Patches (Circle the patch(es) and provide year "patched")
Note: All head coaches, assistant coaches, and "on-bench" teams managers must be patched to the proper level
according to Mass Hockey for the 08-09 season prior to 12/31/08
a.) Initiation ______ (all 1st year coaches) b.) Associate ______ (all 1st year coaches above Imites)
c.) Intermediate ______ (all 2nd year head coaches or Squirt level & up) d.) Advanced_____
e.) NOT PATCHED

III.) 1st Choice: (This choice will be the voted on by the Board)
Age Division: Midget     Bantam    PeeWee    Squirt     Mite     Instructional Mite
Team: "1"     "2"    "3"   "4"   "5"    Valley Buzzer 1     Valley Buzzer 2

IV.) 2nd Choice: (2nd choice will be voted on only after 1st Choice candidates have been eliminated )
Age Division: Midget     Bantam    PeeWee    Squirt     Mite     Instructional Mite
Team: "1"     "2"    "3"   "4"   "5"    Valley Buzzer 1     Valley Buzzer 2

V.) Playing & Coaching Background (attach Hockey resume, if available)
Youth Hockey: _______________________________________________________
High School:________________________________________________________
College: ___________________________________________________________
Other:_____________________________________________________________

VI.) What teams have you coached in the past (any sport / any association )
______________________________________________________________________________
______________________________________________________________________________

VI.) What day / time do you request for practice (decided by coach’s seniority, division, and team level)
Monday             Wednesday            Friday    (subject to change by Hockeytown)
5:20 PM                 5:20 PM                  5:20 PM 
                                                                 5:40 PM 
6:30 PM                6:30 PM                   6:30 PM 
                               6:50 PM