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* 1. What is your first name?

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* 2. What is your last name?

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* 3. What is your email address?

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* 4. What is your phone number?

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* 5. In what city do you live? (To help place you from a location standpoint)

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* 6. What is your USA Hockey CEP number? If you are not yet a certified USA Hockey coach, you may write "Not yet certified".

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* 7. Please list your coaching experience (where you have coached, what levels, and major successes, etc.)

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* 8. What is your current USA Hockey coaching level?

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* 9. Rank which age level(s) you would like to coach (1 is your top choice):

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* 10. Would you prefer to work with Elite/Travel or Development/House

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* 11. Are you interested in being a Head Coach, Assistant Coach, Goalie Coach or Skills Coach?

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* 12. If you do not get picked to be a head coach, would you be interested in being an assistant coach?

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* 13. Have you ever coached girls hockey before?

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* 14. Explain why you want to coach girls hockey:

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* 15. Do you have a daughter in the program and if so, which team is she on?

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* 16. Will you be open to coaching Summer Kachinas skates to better familiarize yourself with your potential players?

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* 17. How would you describe yourself as a coach?

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* 18. Anything else we should know?

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* 19. Please list at least one reference (Name, Phone Number, Email) who could speak to your coaching style and ability.

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