Coach / Unified Partner / A Volunteer Application
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1
2This is an “A” Volunteer application specific to individuals wanting to become a coach, unified partner or volunteer
helper. It must be completed prior to participation by all who wish to be associated with S.O.N.M. This document can
also be completed on our secure portal, please visit our website
for further information.
F-Name:_________________________________ M.I.:____ L-Name:_______________________________________
Positions Associated with SONM Sport(s) (Check all for which you are applying):
Coach (or Assistant)
Unified Partner
Volunteer (Chaperone, Driver, Etc.)
SONM Association:
AREA 1
AREA 2
AREA 3
AREA 4
AREA 5
AREA 6
Delegation or Team Associated with:__________________________________________________________________
HOME
WORK
Address:__________________________________
Business:_____________________________________
City:_____________________________________
Address:_______________________________________
State:________ Zip:_______________________
City:__________________________________________
Phone:___________________________________
State:________ Zip:___________________________
Cell:_____________________________________
Phone:________________________________________
Email:____________________________________
Email:_________________________________________
Male
Female
Time lived at current address
Date of Birth:
/
/
Month __________ Year_________
**Furnishing your Date of Birth is NOT optional. It is used to conduct a more accurate background check. It will
then be blackened out to safeguard against any future use.
Please Answer the Following Questions:
1) Do you use illegal drugs?
Yes
No
2) Have you ever been convicted of a criminal offense?
Yes
No
3) Have you ever been charged with neglect, abuse or assault?
Yes
No
4) Has your Drivers License ever been suspended or revoked in any state or other jurisdiction?
Yes
No
5) Is there any other fact or criminal circumstance involving you or your background that would call into question your
being entrusted with the supervision, guidance, and care of people with disabilities or handling of money?
Yes
No
If you answered YES to any of the above, please explain:
__________________________________________________________________________________________________
__________________________________________________________________________________________________
__________________________________________________________________________________________________
Office Use Only
Background Check Ordered _______________
Updated 9/10/2014
Date Background Check Approved ______________________________________________
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