This program was funded in part by a grant from the United States Department of Veterans Affairs. The opinions, findings and conclusions stated herein are those of the author(s) and do not necessarily reflect those of the United States Department of Veterans Affairs.

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* 1. Please enter your contact information:

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* 2. What is your gender?

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* 3. Please briefly describe your coaching experience:

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* 4. Why do you want to become a paratriathlon coach? Please share your answer in 3-5 sentences.

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* 5. Do you have any previous work history working with Veterans?

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* 6. Why do you desire to work with veterans?

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* 7. Do you agree to serve veterans in your local community and expose the sport of paratriathlon to them at no-cost?

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* 8. Do you agree to host a free paratriathlon clinic in your local community that is veteran focused within by the end of 2021?

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* 9. Do you agree to attend a hands-on practical experience clinic to complete your certification by the end of 2021?

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* 10. Do you understand that you will not be receive your complete paratriathlon coach certification until you complete this requirement?

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* 11. Which race/ethnicity best describes you? (Please choose only one.)

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* 12. Please share if you have veteran status:

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* 13. Please share if you are employed by either of the organizations below:

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* 14. Please upload a letter of recommendation to support your application.

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