*First Name:

*Last Name:

*Address:

*City:

*State:

* ZIP:

*Contact Phone:

Employer:

Occupation:

*Date of Birth:

Check here if you are applying to be a SUBSTITUTE Coach only.

*Please select the regions where you are available to coach:

Please indicate your first choice region or school preference if you have one:

How did you hear about

Girls on the Run?

What attracted you to our program?

Have you had experience working with children in any capacity?

Name one of your strengths and one of your challenges, especially in reference to
working with girls?

Please list two individuals who can serve as references for you and your character. A reference check will be completed if you are interested in serving as a coach for Girls on the Run.

Coach training is mandatory for all coach candidates and successful completion of the training is required for coach certification.

*Yes, I will attend a four-hourGOTR training and certification.

GOTR Coaches must be finger-printed and show proof of a current (within four years) negative TB test.

Please briefly list your education background.

Does your company support time off to volunteer? If yes, what Company?

Does your company have a Community Relations department? If yes, contact name and information?

Does your company have a company match program?

Additional Comments:

Coach Contract:

- I am drug and tobacco free and that I do not consume excessive amounts of alcohol.
- I do not have an eating disorder and if I have suffered from an eating disorder in the past, I completed treatment at least one year prior to today’s date.
- I have never been arrested for charges of child abuse, assault, child neglect, or sexual misconduct. I allow Girls on the Run to perform an online background screen through Volunteer Select.

By checking the “I agree” box, I solemnly swear to the statements above.
* I agree.