APPLICANTION FORM2017 Hong Kong ITU Level 2 Coaches Course

Hong Kong – 29 t h November – 3 r d December 2017

GENERIC INFORMATION*

National Federation

First name(as worded on passport)Family name(as worded on passport)Preferred Full Name

Nationality

E-mail address(s)

Phone Number(with country code)

Date of Birth (dd/mm/yyyy)

Gender Male Female

Mailing address (Street, Number)Mailing address(City, Post Code)Mailing Address(Country)Medical Insurance Details (insurance plan and number)Please scan a copy of insurance certificate with your application

-

Please indicate if you have any special nutritional requirements. -

Emergency ContactPlease list name and contact phone number (incl. country code) and email we can use in the case of an emergency.Your level of English(oral) Beginner Intermediate Advanced

Your level of English (written) Beginner Intermediate Advanced

Internet AccessDo you have daily access to Internet? YES NO

Computer / Laptop AccessDo you have daily access to a computer or a laptop? YES NO

ITU Development l ITU Level 2 Coaches Course Appl ication Form l 2017

APPLICANTION FORM2017 Hong Kong ITU Level 2 Coaches Course

Hong Kong – 29 t h November – 3 r d December 2017

COACHING EXPERIENCE / COACH PROFILE*

Years in c oa ch ing

In tr iathlon

In any other sports (P lease speci fy)Lev el of ath lete s c oac he d Ag es of ath lete s c oac he d

Co ac hin g Educ ati on

**L i s t a l l co ach i ng -r e l eva nt edu cation , cou rses , e tc .

Co ac h Profile

**P l eas e, pr ov i de a b r i ef d esc r i ptio n o f t he coac h’s char acter an d ab i l i ties .

Did y ou ta ke a ny IT U C oac hin g Educ ati o n Co urse in the past ? I f , ye s , p le ase spec i f y .

Community Level 1 Level 2

Date of the Course:

Venue of the Course:

Result (failed/qualified/grade etc.):

Re aso n f or n omi nati on

**P ro v ide reason s w hy th i s c oach was cho sen fo r the co urse

* P l e a s e m a k e s u r e t h a t a l l d e t a i l s w i l l b e p r o v i d e d .* * N F s c a n s u p p l e m e n t t h i s i n f o r m a ti o n w i t h t h e c o a c h ’ s s p o r ti n g C V i f a v a i l a b l e

I , t h e u n d e r s i g n e d , R e p r e s e n t a ti v e o f t h e N a ti o n a l F e d e r a ti o n a n d t h e C a n d i d a t e , c e r ti f y , t h a t t h e i n f o r m a ti o n p r o v i d e d a b o v e i s a cc u r a t e , t r u e a n d c o r r e c t .

S i g n a t u r e ( & S t a m p ) o f t h e N a ti o n a l F e d e r a ti o n S i g n a t u r e o f t h e C a n d i d a t e

Forms to be emailed to: Ki Wookyong, ASTC Development Coordinator at ki.wookyong@astc.triathlon.org>

Closing date for applications: Friday 6th October, 2017

ITU Development l ITU Level 2 Coaches Course Appl ication Form l 2017