Application for Becoming an Unleashed Coach
Full Name
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First Name
Middle Name
Last Name
Current Address
Street Address
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State / Province
Postal / Zip Code
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Afghanistan
Albania
Algeria
American Samoa
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Angola
Anguilla
Antigua and Barbuda
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Aruba
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Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
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Ghana
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Greece
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Iran
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Laos
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Liberia
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Madagascar
Malawi
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Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
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United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
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Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
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Email Address
*
Phone Number
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Area Code
Phone Number
How did you hear about Unleashed?
What interested you in this position?
What experience do you have working with girls?
What experience have you had facilitating groups?
What would be important for us to know about you?
What is your experience co facilitating?
What role do you usually play when working on a team?
How do you prefer to receive feedback?
Describe the best supervisory experience you have had in your career?
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COACH MATCHING Location Teams generally meet at a school site. Please let us know areas where you can observe a team:
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Manhattan
Brooklyn
Queens
Bronx
Westchester
New Jersey
Long Island
All Coaches are required to attend mandatory orientation and training that occurs throughout the program session. Your acceptance as a Coach is dependent on your ability to attend orientation. Will you be able to make coach orientation on a Sunday from 11-3:30
All Coaches are required to attend mandatory orientation and training that occurs throughout the program session. Your acceptance as a Coach is dependent on your ability to attend orientation. Will you be able to make coach orientation on a Sunday from 11-3:30
Please Select
Yes
No
Have you ever been convicted of a crime? If yes, please state the offenses, date and location (A child abuse/neglect conviction status or status as a registered sex offender is cause for automatic disqualification. Other convictions will not necessarily be cause for disqualification.)
Is there a fact or circumstance involving your background that would call into question you being entrusted with the supervision, guidance and care of youth or money? If yes, please explain (A registered sex offender living in your household is cause for automatic disqualification.)
Each coach is required to be fingerprinted before starting with a team. Coaches must be fingerprinted for Unleashed. We can NOT share fingerprints with other agencies. We will send qualified coaches materials regarding fingerprinting. Depending on the agency the cost of fingerprinting varies between $10-$25. YOU MUST BE FINGERPRINTED BEFORE YOU BEGIN COACHING. Initial here to indicate you read this statement and agree to be fingerprinted: Note: Some schools may require additional fingerprinting and TB testing for the district. Any additional cost may be waved and financial assistance is also available.
You must have a complete mailing address for each reference. References are mailed a one-page reference sheet. Include someone who knows your skills and abilities working with youth and at least one person who has known you for 2 years. Please include 3 references, name, address, email, phone number for each
Where did you hear about Unleashed?
Upload Resume
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I hereby apply to be a coach in training with Unleashed and agree to all requirements for coaching stated in this application. I consent that Unleashed may use videotapes, photographs, motion pictures, electronic images and/or audio recordings in which I appear for public relations and publicity purposes. I certify that all information provided on this application is true and complete. I understand that falsification or significant omissions of any information may be considered justifications for dismissal if discovered at a later date. I authorize the release of information requested from references.
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