International Team Staffing (ITS)

2

2013

International Team Staffing (ITS)

Program Application

Use ‘Tab key to move between fields; Use ‘Space bar’ to check box.

Contact Information

Name:
Street Address:
City, ST, ZIP Code:
Day Phone: / Cell Phone :
E-Mail Address
USAA Member # / USAA Membership expires: mm/yy

USAA Certification

Participation in the ITS requires a current USAA certification of Regional Coach or higher.
Type of certification:
Level 4-NTS; Level 5-NTS, Master / Location and Date(s) of course
Example: Chula Vista; Aug. 08 / Date of Expiration
(mm/yy)

Archery Activities Check appropriate response(s); Fill in appropriate box

I coach at this level:
check all that apply / JOAD Club College Other:
Name of Club: / City / State:
Number of sessions coached weekly: / Average number of archers per session:
Estimated current number of recurve students: / Estimated current number of compound students:
Previous Team Staff experience: Beginning with the most current, list any prior team staff assignments you have completed.
Event Name & Year / Location / Staff Position
Coaching accomplishments: Please list name of archer(s) you have coached to reach different levels:
Olympic Team: / World Team:
Pan Am Team: / Paralympic:
Sr. USAT: / Jr. USAT:
JOAD Olympian: / All American:
Cadet USAT: / Para USAT:
List any other certifications (you may be asked to provide a copy of your certification card):
Type of certification
(First Aid, CPR, ASEP, etc.) / Certifying agency / Date of Expiration
(mm/yy)
Other: Brief summary of any skills, qualifications or experiences not identified above.
By signing this form, I attest that the information contained herein is truthful. I have kept a copy for my records. Electronic signatures are acceptable.
Signature of applicant: / Date:

Return form to:

Sheri Rhodes fax: 480-497-6906

549 E. Silver Creek Rd. email:

Gilbert, AZ 85296

Deadline for return: November 15, 2012