Application For Temporary Emergency Coaching Permit (Page 3 of 4) in pdf

Application For Temporary Emergency Coaching Permit Page 3

ED 186

PART VIII: EMPLOYING AGENT ATTESTATION

A. Check one:

Initial Permit

Renewal

I am requesting issuance of a Temporary Emergency Coaching Permit for the _________________ school year. This request is made on

the basis of my determination that no certified teacher possessing a coaching permit or noncertified individual possessing a coaching permit

is available for the position and that the applicant meets all requirements for issuance of the permit. The applicant will be supervised and

assisted, as appropriate, by regular observation, guidance and evaluation of performance.

B. For RENEWAL request, also complete this section:

Renewal of the Temporary Emergency Coaching Permit is requested for the following school year:____________________________

The applicant has served successfully as a coach during the school year:__________________________________

C. Signature of Superintendents or Designee required for all requests:

Signature of Superintendent, Executive Director or Designee

Date

(Original Signature: No Signature Stamps Accepted)

Typed or Printed Name of Person Signing Above

Title

Employing Agent

Telephone

Street

E-mail Address

City,

State

Zip Code

Original Signature Must Be On Form Submitted

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Application For Temporary Emergency Coaching Permit Page 3