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Greater Warwickshire Coach Audit

Data Protection Act 1998: The Data Controller is Coventry City Council - The details you provide on this form will be put on Coventry Solihull & Warwickshire Sport Online Coach Directory for use by schools, clubs, local authorities and Coventry Solihull & Warwickshire Sport to help provide you with coaching opportunities. Your information will be shared with Coventry Solihull & Warwickshire Sport partners listed above and also with organisations such as sports coach UK. These parties may contact you directly.

Pre Survey Question : Are you a member of the Greater Warwickshire Female Football Coaches Development Programme? YES NO

Personal Details
Title
First Name
Surname
Date of Birth
Gender	FEMALE MALE
Telephone No.
Mobile No.
Postal Address Line 1
Postal Address Line 2
Postal Address Line 3
Post Code
E-Mail Address
Do you consider yourself to have a disability?	YES NO
If you have answered yes to the above question, what is the nature of the impairment?
What is your ethnicity?

Please tick areas you are willing to travel to coach in
Coventry City
North Warwickshire Borough
Nuneaton & Bedworth Borough
Rugby Borough
Solihull Metropolitan Borough
Stratford on Avon District
Warwick District

Qualifications & Experience
What sport(s) are you qualified to coach?
What sports specific qualifications do you hold?
Which sports coach UK courses have you attended?	eg. 'Equity in Your Coaching' or 'Good Practice & Child Protection'
Do you have the use of a car?	YES NO
Do you have experience working with people with disabilities?	YES NO
Do you have experience working in schools?	YES NO
Is your previous coaching primarily:
Please inform us of your employment status for coaching:
Are you a full time, or part time coach?
Brief coaching history:	Please state; what sports you have coached, what level of performer you have coached and average group sizes you have worked with.
Please use this section to provide info on any other relevant training or qualifications you have undertaken

National Governing Body / Association Involvement
Are you a member of a National Governing Body/other coaches association?	YES NO
If you have answered 'yes' to the above question, which organisation?
Do you hold an NGB Coaching Licence?	YES NO
If you have answered 'yes' to the above question, when does the licence expire?
Are you a member of a sports club within Coventry, Solihull & Warwickshire?	YES NO
If you have answered 'yes' to the question above, please state the name of the club.
If you have answered 'yes' to the question above, does the club have Clubmark or NGB accreditation?	YES NO

First Aid
Have you attended a First Aid course?	YES NO
Who was the course provider?
If you answered 'other' to the above question, please state which provider:
When does your first aid qualification expire?

Child Protection
Have you attended a Child Protection course?	YES NO
Who was the course provider?
Have you completed a Criminal Records Bureau disclosure?	YES NO
What level was the Disclosure?
Which organisation facilitated your disclosure?
On what date did you complete your disclosure?

Public Liability Insurance
Do you hold Public Liability insurance?	YES NO
Who is the provider of your Public Liability insurance?
When does your public liability insurance expire?

Availability (in general)
Weekday mornings (approx. 8am - 12noon)
Weekday afternoons (approx. 12noon - 3pm)
Weekday after schools (approx. 3pm - 6pm)
Weekday evenings (approx. 6pm - 9pm)
Weekend mornings (approx. 8am - 12noon)
Weekend afternoons (12noon - 5pm)
Weekend evenings (5pm - 9pm)

You may be contacted by other sporting organisations offering you relevant services. If you do not want to be contacted by such organisations please check this box.

Tick this box if you would like to be added to the Greater Warwickshire Sport Partnership 'e-update' service, which provides regular electronic news updates (A valid e-mail address must be provided above to subscribe)

c/o University of Warwick
Westwood Campus
Coventry, CV4 7AL

T 024 7657 4200
F 024 7657 4203
E info@cswsport.org.uk


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