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Recognition of Current Competency (RCC) Application Form Kyorugi Coach CANDIDATE INFORMATION Name: Mr / Mrs / Miss Date of Birth: Address: State: Postcode: Phone: Mobile: Email: AT Member Registration # ACCREDITATION HISTORY To ensure that we have your full accreditation history, please list all your accreditations and the dates obtained. Please supply scanned copies of any certificates issued; this will make it easier to verify your qualifications. TA accreditation OTU accreditation ASC Courses Level Date Obtained Certificate Number Class Date Obtained Certificate Number Course Date Obtained Certificate Number 1 1 Anti Doping 2 Child Protection Harassment & Discrimination COACHING EXPERIENCE Please provide sign off of your 50 hours coaching experience in 2016. I (insert verifier’s name)…………………………………………..confirm that (insert applicants name) ……………………………………………has carried out 50 hours of coaching in 2016. Signed…………………………………………………..Date: ……………………………………. DECLARATION COACHES DECLARATION • I have fulfilled all requirements required to be eligible for consideration • To the best of my knowledge, the information in this application is correct and complete • I understand that submitting false or misleading information may result in any RCC grading given being withdrawn at any stage. • I understand that AT reserves the right to vary or reverse any decision made on the basis of incorrect or incomplete information • I authorise AT to conduct a search and retrieval of my referee records from TA/OTU/STA/WTF to verify information contained in my application. I agree to the above mentioned declaration Signature: Date: Please forward via email to [email protected] by 28 February 2017 with scanned copies of your certificates.
