- LAUSD Office of Interscholastic Athletics

Year ______________

SPRING SUPPLEMENTAL COACHING ASSIGNMENTS

Name Employee Status (Last, First, M. Init.) Number AA, Perm, LTS.

1. BASEBALL, Var. / /_________________________ Rate 6, $2,512 (Wage Type: 1407)

Home Address_____________________________________________________ Telephone (_______)_______________

SS# E-Mail Address____________________________________________

2. BASEBALL, JV / /_______________________________ Rate 4, $2,102 (Wage Type: 1403)

Home Address_____________________________________________________ Telephone (_______)________________

SS# E-Mail Address_____________________________________________

3. GOLF _________ / /__________________________________ Rate 3, $1,691 (Wage Type: 1402)

Home Address_____________________________________________________ Telephone (_______)_________________

SS# E-Mail Address__________________________________________

4 SWIMMING, Head Var / /___________________________ Rate 4, $2,102 (Wage Type: 1403)

Home Address_____________________________________________________ Telephone (_______)_________________

SS# E-Mail Address_________________________________________.

5. TENNIS, M / /___________________________ Rate 4, $2,102 (Wage Type: 1403)

Home Address_____________________________________________________ Telephone (_______)_________________

SS# E-Mail Address________________________________________

. 6. TRACK & FIELD, Var. Boys / /___________________ Rate 6, $2,512 (Wage Type: 1407)

Home Address_____________________________________________________ Telephone (_______)________________

SS# E-Mail Address______________________________________

7. TRACK & FIELD, Var. Girls / /______________ _________ Rate 6, $2,512 (Wage Type: 1407)

Home Address_____________________________________________________ Telephone (_______)_________________

SS# E-Mail Address_______________________________________.

8. AA TRACK & FIELD* / /_____________________________ Rate 3, $1,691 (Wage Type: 1402)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address_________________________________________

*If the school team has 20 or more athletes, the differential for the coach is:

Wage Type Class Title Rate Program Code 1403 Coach, AA Track & Field $2,102 (4) 1/1050

9. VOLLEYBALL, Var. M / /_________________________ Rate 5, $2,311 (Wage Type: 1404)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address__________________________________________.

10. VOLLEYBALL, M/JV / /_________________________ Rate 3, $1.691 (Wage Type: 1402)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address_________________________________________

11. SOFTBALL, Var. / /_______________________________ Rate 6, $2,512 (Wage Type: 1407)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address______________________________________________

12. SOFTBALL, JV / /________________________________ Rate 4, $2,102 (Wage Type: 1403)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address__________________________________________________

13. LACROSSE M / /____________________________ Rate 3, $1,691 (Wage Type: 1402)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address__________________________________________

14. LACROSSE W / /____________________________ Rate 3, $1.691 (Wage Type: 1402)

Home Address_____________________________________________________ Telephone (_______)__________________

SS# E-Mail Address__________________________________________

ATHLETIC DIRECTOR (Wage Type: 1410) $2,811

SPRING SEMESTER / /________________________

Home Address________________________________________________ Telephone (_______)_____________________

SS# E-Mail Address___________________________________________

ASSISTANT ATHLETIC DIRECTOR (Wage Type: 1403) $2,102

SPRING SEMESTER / /_________________________

Home Address________________________________________________ Telephone (_______)______________________

SS# E-Mail Address_______________________________________________

AUXILLARY COVERAGE FOR ATHLETIC DIRECTOR( 1 OR 2 PERIODS)

1. PERIOD COVERAGE: __________ SUBJECT______________ ATHLETIC DIRECTOR CREDENTIAL SUBJECT______________

NAME OF TEACHER AND EMPLOYEE # GETTING AUXILLARY ________________________________________________________

2. PERIOD COVERAGE: __________ SUBJECT______________ ATHLETIC DIRECTOR CREDENTIAL SUBJECT______________

NAME OF TEACHER AND EMPLOYEE # GETTING AUXILLARY ________________________________________________________

School___________________________________________ LOCATION # ________________________________________________

SCHOOL ADMINISTRATIVE ASSISTANT SIGNATURE ___________________________________________ DATE _______________

PRINCIPAL’S SIGNATURE __________________________________________________________________DATE________________

CHECKLIST

______ I have attached the “Employment of Athletic Assistant Form” for all non-certificated coaches. and Freeze exemption form (if it applies).

______ I have answered the Coaching Education information for each coach.

______ I have written the word “None” or DNF in any assignment for which we donot field a team.

______ I have completed and included the Title V, S.B. 435 Certification and Coaching Ed requirement

SCHOOL _______________________________________ LOC. NUMBER _____________ DATE ____________________

ADMINISTRATOR’S SIGNATURE ___________________________________ TITLE ______________________________

ATHLETICS OFFICE FAX 213-241-5846

   LAUSD Interscholastic Athletics Office

SPRING SPORT SEASONTitle V, S.B. 435 Certification and Coaching Education Requirement

Each Season, we are required to verify that all paid athletic coaches meet the Coaches Education Requirement, Title V of the Education Code, and in many cases, the provisions outlined in S.B. 435. Reporting will be done on a single form, rather than a separate sheet for each.

Each local school site must keep copies of the verifying documents:1. A valid and current First Aid and CPR card on file - to fulfill the Title V requirement.2. A certificate on file that verifies successful completion with a passing score on the coaching principles and concussion training.

Each paid coach, whether certificated or an Athletic Assistant must be reported under the Title V, Code of Conduct, Coaching Education and Concussion Training Column. As per IAC rule 126-6, a paid coach must possess a valid First Aid and CPR card by the first day of after-school practice. This form, signed by the Principal, must be submitted to the Athletics Office by the first day of practice.

Only those certificated persons who are teaching a physical education class in athletics and do not hold a Physical Education Credential, a General Credential or some other authorized credential to teach Physical Education, need to be reported under S. B. 435.* Some people will be reported in both columns.

Print name and employee number of each coach. Boxes should be checked off to verify they have met the Title V requirement, Coaching Education, Concussion Training requirements and signed the Coaches Code of Conduct. . Only fully credentialed teachers are eligible to obtain a one period coaching authorization to teach physical education during the regular school day, if not credentialed in physical education (SB 435).” Check SB 435 only if the coach is qualified for the teaching credential waiver.

SPORT NAME EMPLOYEE #

FIRST AIDCPR

CODE OF CONDUCT COACHING

ED. CONCUSSION

TRAINING

S.B. 435

CHILD ABUSE

Baseball, Var.

Expiration Date

  met

Date Expiration Date

  need   met

Baseball,., JV

Expiration Date

  met

Date Expiration Date

  need   met

Lacrosse ,Var. M

Expiration Date

  met

Date Expiration Date

  need   met

Lacrosse, Var. W

Expiration Date

  met

Date Expiration Date

  need   met

Softball, Var.

Expiration Date

  met

Date Expiration Date

  need   met

Softball JV

Expiration Date

  met

Date Expiration Date

  need   met

Swimming, Head

Expiration Date

  met

Date Expiration Date

  need   met

Tennis, M

Expiration Date

  met

Date Expiration Date

  need   met

Track & Field, Var. Boys

Expiration Date

  met

Date Expiration Date

  need   met

Track & Field Var. Girls

Expiration Date

  met

Date Expiration Date

  need   met

SPORT NAME EMPLOYEE #

FIRST AIDCPR

CODE OF CONDUCT COACHING

ED. CONCUSSION

TRAINING

S.B. 435

CHILD ABUSE

AA Track & Field

Expiration Date

  met

Date Expiration Date

  need   met

Volleyball Var. M

Expiration Date

  met

Date Expiration Date

  need   met

Volleyball JV M

Expiration Date

  met

Date Expiration Date

  need   met

Student Golf

Expiration Date

  met

Date Expiration Date

  need   met

Principal’s Signature Date________________

School

RETURN TO ATHLETICS OFFICE BY THE START OF SPRING PRACTCE. FAX COMPLETED FORM (213) 241-5846

LOS ANGELES UNIFIED SCHOOL DISTRICTOffice of Interscholastic Athletics

EMPLOYMENT OF ATHLETIC ASSISTANT FORM

NOTE: Before completing this form, read attached guidelines for hiring and payroll procedures.

THIS FORM DOES NOT AUTHORIZE EMPLOYMENT. Each person must be processed and approved by Classified Personnel Division and a “greenie” for each position must be created before any time may be reported. This process can only begin when this form is received in the Athletics Office.

The position of “Athletic Assistant” is a classified position and is paid monthly for time reported. Please see page two of this form indicating the maximum number of hours for which an “Athletic Assistant” can be paid for specific coaching assignments. In addition, the number of hours reported is not to exceed 75 hours in any single pay period, except for a Campus Aide’s hours, which may be distributed throughout the school year, not to exceed 799 hours when the total number of hours for the two assignments is combined.

Name of Athletic Assistant Position to be Filled Emp. No.* Coaches Pay Rate Effective Date School Location(See Below) ( Rate # 1-6) Code Needed

1. _______________________ _________________ ____________ _________________ ___________ _______________

2. _______________________ _________________ ____________ _________________ ___________ _______________

3. _______________________ _________________ ____________ _________________ ___________ _______________

4. _______________________ _________________ ____________ _________________ ___________ _______________

5._______________________ _________________ ____________ _________________ ___________ _______________

____________________________________ ______________________________________ ____________________School Principal’s Signature Date

______________________________________ ____________________School Payroll Clerk’s Signature Date

* If the employee number is not yet known, school must indicate “In Process.” This information will be verified with the Classified Personnel Office. The employee number must be submitted to the Athletics Office when it becomes available.

NOTES: 1. All newly hired paid coaches must complete the ASEP/CIF Coaching Education and must have certification of current CPR , First Aid and Concussion Training on file at the school.

2. All Athletic Assistants must be cleared and approved by Classified Personnel in order to begin the assignment.

3. Schools must check with Classified Personnel prior to re-assigning a current or returning employee in order to determine if the employee has satisfied all qualifications for employment.

APPROVED: __________________________________________ _______________________Director, Interscholastic Athletics Date