Sports Training Application Form - Special Olympics
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1SPORTS TRAINING APPLICATION
Instructions: Please print clearly and return to the address at the bottom of this application.
**Remember you must take General Orientation and Protective behaviors on-line in order to be a coach.
1.
List the information requested in the boxes below (please print your name as it appears in the SOPA Database):
Name:
Address:
City:
State:
Zip:
Daytime/Cell Phone: (
)
Local Program
email address:
If your address has changed since your last certification, please check this box.
ONE
2. Level 2 - I am applying for CREDIT in
of the following Two Tracks:
Track 1 (New Coach) **
Track 2 (Coach with Sport Experience approved by SOPA) **
Skills - Sport ___________
Coaching Special Olympics Athletes Course
Sport ___________
This above training course is being held on
____/____/____ at _________________________.
Date
City/State
PRACTICUM (For Track 1 and 2 Only)
A minimum of 10 hours
working with Special Olympics Athletes in the sport listed above is required to complete your Level 2
•
Certification..
• Up to five hours of coaching, with a certified coach during the training season that is taking place prior to the course. (ex. if
you have 5 training sessions before you take your sport training, you may use 5 hours from this time as long as you were
coaching under a certified coach)
• No more than three hours may be used from coaching during a competition (no matter how many days).
DATE
# of Hours
# of Athletes
I am applying for Continuing Education in one of the following (no practicum needed):
3.
Multiple Sport Continuing Ed. **
Single Sport Continuing Ed.
Motor Activities Training Program (MATP)
Cont. Ed. Sport Specific Clinic -Sport ___________
Coaching Special Olympics Athletes Course
Tactics – Sport _______________
Games Management Training
Official – Sport _______________
Principles of Coaching
Unified Sports® Module 1
Unified Sports® Module 2
Positive Coaching Alliance - (attach copy of certificate)
First Aid or CPR (can be used once every nine years) - (attach copy of certificate)
Protective Behaviors Training (can be used once every nine years)
Other (Pre - Approved by SOPA) ______________________
**Sport or Sports - ______________________________________
4. Having satisfactorily completed all requirements, I hereby request Special Olympics certification or Continuing Education
Credit in the area identified above.
_________________________________ ____/____/____
_________________________________ ____/___/______
Signature of Applicant/Coach
Date
Signature of Practicum Supervisor
Date
(Local Training Coordinator, Local Certified Head Coach)
Please make a copy for your personal and your local program’s records and then email this document to
or fax to 814.234.7905
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