NCYSA | Youth Academy

This is an application for your organizations “Intent to Play” as part of the NCYSA |Youth Academy Program

Fall 2017

Please fill out all fields on this form. DO NOT LEAVE ANY BLANKS!

Association: ______

[ ] Our association will offer a U8-U10 NC Youth Academy program for the Fall 2017

Estimated Number of TEAMS for Games: [ ] Total Teams [ ] Male [ ] Female

[ ] Our association will offer a U11-U12 NC Youth Academy program for the Fall 2017

Estimated Number of TEAMS for Games: [ ] Total Teams [ ] Male [ ] Female

NC Youth ACADEMY DIRECTOR/COORDINATOR

The official liaison for the association’s academy program needs to complete the information below.

This person will receive all correspondence and will be the point of contact for the association’s NC Youth Academy program.

Name______

Address______City______Zip______

Phone (H) ( ) ______Phone (W) ( ) ______

Cell ( ) ______Fax ( ) ______

E-mail address______

Qualifications (this information must be completed – Copies must be included)

USSF National Youth Coaching Course

·  [ ] Yes

·  [ ] No

USSF Youth II Module

·  [ ] Yes

·  [ ] No

USSF / NSCAA National Qualifications

Please check the appropriate box below:

[ ] Our association accepts and understands the rules of the NC Youth Academy Program

Including, but, not limited to:

·  Only players that are true U8 thru U12 as per US Soccer Federation Guidelines are eligible for the Academy Program.

·  Our association accepts and understands that no scores or standings are/will be published for NC Youth Academy Games.

·  Our association accepts and understands that each NC Youth academy player will receive a minimum of two written evaluations per year from their NC Youth Academy.

·  Associations must administer an NC Youth Academy Parent Education program in accordance with the NC Youth Academy philosophy.

·  Our association accepts and understands that they need to:

o  Attend the two seasonal (Fall/Spring) NC Youth academy scheduling meetings

o  They are responsible for scheduling their NC Youth academy games.

·  Our association accepts and understands that

o  All NC Youth academy staff coaches hold (1-year grace period from date of intent)

§  Youth Module II

o  NC Youth Academy Director/Coordinator must hold (2-year grace period from date of intent)

§  National Youth Coaches Course Certificate

§  Youth Module II

BOTH SIGNATURES BELOW ARE REQUIRED FOR ACCEPTANCE

I confirm that I have read the most current Academy Rules, and will discuss its contents with the players and parents involved.

NC Youth Academy Director/Coordinator______Date ______

Association President/ Designee ______Date ______

PLEASE RETURN THE NC Youth ACADEMY INTENT TO PLAY FORM TO:

NCYSA · Academy Intent to Play · PO Box 18229 · Greensboro, NC 27419

POSTMARK DEADLINE FOR ACCEPTANCE: Friday May 26, 2017

Eric Redder, Assistant Technical Director - | Debbie Morton, Youth Academy Admin-