Application for Sports Training Certification

(One form per certification)

Mentoring

Instructions: Please print clearly or type information below and return to your local program office.

List Permanent Mailing Address and telephone number:

Name: / Address:
City: / State: Zip:
Daytime Phone: ( ) / Evening Phone: ( )
email address: / Male  Female 

If your address has changed since your last certification, please check this box. 

1. I have taken the Special Olympics General Orientation and protective behaviors online on ____/____/____

date

  1. I have completed Concussion Training on ____/____/____

date

  1. The TRAINING SEMINAR/COURSE was held in ______Mentoring Program______on ____/____/____

date

  1. I am applying for CERTIFICATION in one of the following areas:

 Skills, Sport ______

4. Coaching/Officiating experience at the high school or college levels:  Yes No (circle Coach or Official)

Playing experience at the high school or college levels:  Yes  No

Sport(s): ______

  1. PRACTICUM – a minimum of 10 hoursworking with a current certified coach and with Special Olympics athletes is required. Officials, Competition Management members, and Games Management Team members may include a minimum of 10 hours in preparing for and/or in conducting competition. All applications must have practicum hours listed.

Date / # of Hours / # of Athletes / Date / # of Hours / # of Athletes / Date / # of Hours / # of Athletes
  1. Other Information:

How many Special Olympics sports do you coach? ____ In how many sports are you certified? ____

Highest level of education achieved: ______

Do you have any relatives with an intellectual disability?  Yes No If yes, relationship ______

If you are an athlete becoming a coach, please check this box. 

  1. Having satisfactorily completed all requirements, I hereby request Special Olympics certification in the area identified above. I have also completed the following

□Mentor checklist by certifying coach□ copy of application & $10 to State Office

______

Applicant Date Local Program Coordinator Date Sport Director Date

Make copies as needed and send the original for certification

Certification through the Mentoring Program

This process is intended for those coaches who have coached outside of Special Olympics for many years (possibly at the high school or college level), and therefore, do not need to attend the training courses, which focus on the basic fundamentals and skills of a particular sport. These coaches can apply to be certified via the Mentoring Program. They have to coach with a certified Special Olympics coach in their particular sport for ten hours and do some additional work, outlined below. The idea behind this is that these coaches learn how to coach Special Olympics athletes, which as we all know can be different than coaching at the high school or college level. After the coach has coached for the ten hours and done the additional work outlined, they submit the form to the State Office.

To become certified through the Mentoring Program, coaches need to do the following:

  • Coach with a certified coach, in the sport you would like to become certified in, for ten hours. Cover the material listed on the training agenda.
  • Take and successfully complete the online General Orientation and Protective Behaviors Quiz at click on “Sports” and “Coaches Corner”
  • Complete concussion training and submit documentation to the State Office.
  • Complete the necessary criteria on the log sheet for the Mentoring program
  • Fill out and return the application for certification, as well as the log sheet.

In order to keep your certification current, you must do one of the following once every 3 years:

  • Become certified in another sport or and advanced session of the same sport you were certified initially, either by the regular certification process of attending a training school, or through the mentoring program.
  • Attend a session that will increase your knowledge as a coach (ie. First Aid, CPR, an approved sport-related class outside of Special Olympics)
  • Watch a Sport Training video found at and take the recertification quiz that follows.