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SOCCER
IN THE STREETS Date:__________________________ Name: _________________________________________________________________ Address: _______________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Phone: (Home)___________________(Work): ____________________(ext)_________ Fax: ___________________________ Email:__________________________________ Best time to call: ________________________________________________________ Interest: _______________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Background Information: (i.e. coaching experience, teacher, mentoring, tutoring…etc.) ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ PROGRAM AFFILIATE CHECKLIST Please check all that apply: Program Director should meet minimum requirements- ____ Time available to commit should be no less than 20 hours per week ____ Organizational skills - either by training or experience ____ Reputable in the community ____ Communications skills - written, verbal Director of Coaching should meet minimum requirements- ____ Time available to commit should be no less than 10 hours per week ____ NSCAA National certification or equivalent ____ Familiarity with local and regional soccer organizational structure ____ Rapport with targeted community Offices ____ Locating within existing organization's facilities - i.e. youth recreational facilities, community service agency facilities, churches, home office, etc. ____ Commercial lease ____ Required amenities - includes phone with message system, fax, computer, email, space for storage of files, supplies and some equipment Recreational facilities (Using existing facilities) ____ Indoor and outdoor areas should be spacious enough to accommodate the number of children served and/or adjust groups to be workable within allotted space ____ Areas should be free from dangerous conditions, such as broken glass, severely uneven or rough surfaces, substandard equipment, etc. ____ Adequate security should be provided for participants, spectators, coaches, staff and volunteers ____ Running water, restroom facilities, shelter, telephone and first aid should be within close proximity of the site ____ To facilitate usage for ongoing soccer events, a site should have portable and/or permanent goals and should be within close proximity to storage space for equipment ____ Aesthetic features should also be considered for a location: Is the park/gym clean? In disrepair? Marred with graffiti? Are there trees in the park? Places for participants and spectators to sit, watch and rest? Is there parking? Is it accessible? Is the location warm and welcoming or cold and institutional? (Developing new facilities) ____ A local program should work to develop relationships with other organizations that own/control/have access to existing facilities, such as the YMCA, Boys & Girls Club, Parks & Recreation Department, community centers, churches ____ Other avenues to develop new facilities include grants specifically designed for capital improvement projects, such as community block grants and the United States Soccer Foundation Funding ____ Ability to do local fundraising (i.e. raffles, car washes, ads, etc.) ____ Ability to obtain funding from local community (i.e. grocery, fast food, churches, etc.) ____ Ability to obtain funding from local corporate sponsors (i.e. banks, government offices, etc.) List any additional information that may be relevant to your program: ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ ________________________________________________________________________ For additional information, please contact:
Return this application, along with the $50 affiliate application fee, to the address above. - - - - - - - - - - - - - - - - - - - - - - - FOR OFFICE USE ONLY - - - - - - - - - - - - - - - - - - - - Fee received by:____________________________ Cash / Check #: _______________ |
