Essex County Football Association Coaches Association

8/14/2019 Essex County Football Association Coaches Association

http://slidepdf.com/reader/full/essex-county-football-association-coaches-association 1/3

Essex County Football AssociationCoaches Association

Application Form and Coaching Profile

Return this form to:- Gary Piggott, Coaching Development Officer,ECFA, The County Office, Springfield Lyons Approach, Springfield,

Chelmsford, Essex, CM2 5LB.Telephone: 01245 393088

Please enclose a cheque for £15 (Non Charter Standard) or £10 (Charter Standard)

payable to: ECFA Ltd (No cash to be posted) and 2 passport photos.

Please complete all sections in BLOCK CAPITALS. (All information will be confidential)

First name Title

Surname

Gender Male / Female Date of Birth / /

Full PostalAddress

_______________________________________________________________

_______________________________________________________________

Postcode Email

Home Phone

Work Phone

Mobile Phone

Club or School Name(If applicable)

FA/UEFA Qualifications held,

Level 1, Level 2, Level 3 etc.and date received

No Qualification as yet

FACA Membership No.

Brief CV of coaching history

CV summary of other relevantawards heldTeacher/other sport coachingawards/Unit D32/D33/A1 etc



Disability

Do you have any learning difficulty or disability? Yes / No

If yes, please state:

…………………………………………………………………………………………………………………..

Ethnicity I would describe my ethnic origin as:

NB: We would expect all members to have started the CRB process

Would you like to be added to Coach Database Yes / No

Asian British Bangladeshi Indian Chinese

Asian British Indian Mixed White and Asian Pakistani

Asian British Pakistani Mixed White and Black African Prefer not to say

Bangladeshi Mixed White and Black Caribbean White British

Black African Other White European

Black British Other Asian White Irish

Black Caribbean Other Black White Non European

Do you hold a current Emergency First Aid Certificate – Date awarded Yes / No -

Have you completed a Child Protection Workshop – Date awarded Yes / No -

Have you completed the FA CRB process – Date awarded Yes / No -

CRB Reference Number

Signature Date

FOR OFFICE USE ONLY

Membership No: Expiry Date:



Essex County Football Association

Football Development

The Essex FA are looking to raise the standards of football at all levels in the

County.

Our aim is to be supportive and keep football coaches both male and femalewell informed, in all aspects of their personal development.

So if you are looking to enhance your knowledge, share good practice and

network with like minded people, then I would like to take this opportunity toinvite you to join the Essex Coaches Association.

The cost to join will be:-

Charter Standard Coach: £10.00 a yearNon Charter Standard Coach: £15.00 a year.

The membership fee will include many benefits.

As a member you:-

• Will have the opportunity to attend 4 events per year.• Will receive a membership card.

• Can gain practical help for your coaching.• Can access mentoring opportunities.• Will receive a bi-annual newsletter.• Will be able to share ideas and information.• Receive email updates.

• Can receive discounts on Umbro kit and equipment.(Charter Standard clubs)

You will have the opportunity to be included on the Essex Coaches Databasewhich will be made available to clubs or organisations requesting qualified

coaches.

If interested in joining, complete the Application Form and return with cheque

and to:-

Gary Piggott, Coaching Development Officer,ECFA, The County Office, Springfield Lyons Approach, Springfield,Chelmsford, Essex CM2 [email protected]

Documents

Essex County Football Association Coaches Association