Application to Host Coaching School or Clinic

Ž Host A Coaching School Ž Host a Clinic

Course Level Clinic Topic

Expected # of Attendees Expected # of Attendees

Sponsoring Organization

Name of School Coordinator

Address City State ZIP

Home Phone: ( ) Work Phone: ( ) Fax: ( )

Date course begins: 1^st Choice: 2^nd Choice:

List below the dates that you are requesting:

School and/or field where course is to be held:

Address City State ZIP

Signature of League Official Title

Signature of Coordinator Title

Please Complete and Return to: EPYSA

2 Village Road, Suite 3

Horsham, PA 19044*Fax: 215-657-7740

For Office Use Only

Date Received: Faxed: Date Approved: Instructor: