Host a Community Coaching Course Application Form

Club Name*

Club Contact / Course Coordinator Name*

This should preferably be the Club Coach Coordinator (CCC)

First Last

Contact Number*

Contact Email Address*

Proposed Course*

MiniRoos Certificate (4-8 years)
Skill Training Certificate (9-12 years)
Game Training Certificate (12-17 years)
Senior Certificate (17+ years)

Proposed Venue Name*

Proposed Venue Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Preferred Start Date(s)*

Alternative Preferred Start Date(s)*

Preferred Start Time*

: HH

MM

Alternative Preferred Start Time*

: HH

MM

Number of your club coaches attending*

For a course to go ahead there must be a minimum of 12 confirmed attending coaches - where support is required to achieve these minimum participation numbers the MFA Community Football Manager can provide support via promotion to other local clubs.

Our club can provide the following equipment (if required):*

Our club will make the following pitch space available:*

1/8 pitch (MiniRoos only)
1/4 pitch (minimum required for Skill Training)
1/2 pitch (minimum required for Game Training & Senior)

Our club can provide these facilities:*

Meeting room
Audio / visual equipment (e.g. projector or screen for presenting content)
Male and Female change rooms and toilets
Refreshments for participants (e.g. tea, coffee, water or open canteen)
None of the above
Other

Please Specify Other*

Additional comments:

Feel free to provide any further information (e.g. your long term coach development plan at the club) or ask any questions here.

Please note that submission of this form does not guarantee a course will be scheduled. After submitting the form, the Community Football Manager will be in contact within 48 hours to confirm and discuss further.

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