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* 1. First Name

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* 2. Last Name

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* 3. Contact Information

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* 4. US Soccer License held

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* 5. United Soccer Coach Certification

 
Master Coach
Premier
Advanced National
Other

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* 7. What additional experiences do you have coaching soccer?

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* 8. What gender would you prefer to coach?

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* 9. What age would you prefer to coach? 

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* 10. Please provide 2 references - name, relationship, phone, email

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