LAUSD Office of Interscholastic Athletics
Year ______
WINTER SUPPLEMENTAL COACHING ASSIGNMENTS
NameEmployee Status
(Last, First, M. Init.)Number AA, Perm, LTS
1. BASKETBALL, Varsity M / /______
Rate 6, $2,512 (Wage Type: 1407)
Home Address______Telephone (______)______
SS# E-Mail Address______
2. BASKETBALL, M/JV / /______
Rate 3, $1,691 (Wage Type: 1402)
Home Address______Telephone (______)______
SS# E-Mail Address______
3. BASKETBALL, Varsity W / /______
Rate 6, $2,512 (Wage Type: 1407)
Home Address______Telephone (______)______
SS# E-Mail Address______
4. BASKETBALL, W/JV / /______
Rate 3, $1,691 (Wage Type: 1402)
Home Address______Telephone (______)______
SS# E-Mail Address______
5. SOCCER, Head M / /______
Rate 6, $2,512 (Wage Type: 1407)
Home Address______Telephone (______)______
SS# E-Mail Address______
6. SOCCER, Asst. M/JV / /______
Rate 3, $1,691 (Wage Type: 1402)
Home Address______Telephone (______)______
SS# E-Mail Address______
7. SOCCER, Varsity W / /______
Rate 6, $2,512 (Wage Type: 1407)
Home Address______Telephone (______)______
SS# E-Mail Address______
8. SOCCER, W/JV / /______
Rate 3, $1,691 (Wage Type: 1402)
Home Address______Telephone (______)______
SS# E-Mail Address______
9. WATER POLO W / /______
Rate 4, $2,102 (Wage Type: 1403)
Home Address______Telephone (______)______
SS# E-Mail Address______
10. ***WRESTLING (Boys) / /______
Rate 4, $2,102 (Wage Type: 1403)
Home Address______Telephone (______)______
SS# E-Mail Address______
11. *** WRESTLING (Girls) / /______
Rate 4, $2,102 (Wage Type: 1403)
Home Address______Telephone (______)______
SS# E-Mail Address______
*** For a school to receive both Wrestling stipends, minimum of at least 10 wrestlers of each gender must participate throughout the entire season. If not, only one stipend will be provided for wrestling.
CHECKLIST
______I have attached the “Employment of Athletic Assistant Form” for all non-certificated coaches and Freeze exemption form (if it applies).
______I have answered the Coaching Education information for each coach.
______I have written the word “None” or DNF in any assignment for which we do
not field a team.
______I have completed and included the Title V, S.B. 435 Certification and Coaching Ed
requirement
SCHOOL ______LOC. NUMBER ______DATE ______
ADMINISTRATOR’S SIGNATURE ______TITLE ______
ATHLETICS OFFICE FAX NUMBER 213-241-5846
LAUSD Interscholastic Athletics Office
WINTER SPORT SEASON
Title V, S.B. 435 Certification and Coaching Education Requirement
Each Season, we are required to verify that all paid athletic coaches meet the Coaches Education Requirement, Title V of the Education Code, and in many cases, the provisions outlined in S.B. 435. Reporting will be done on a single form, rather than a separate sheet for each.
Each local school site must keep copies of the verifying documents:
- A valid and current First Aid and CPR card on file - to fulfill the Title V requirement.
- A certificate on file that verifies successful completion with a passing score on the coaching principles and concussion training.
Each paid coach, whether certificated or an Athletic Assistant must be reported under the Title V, Code of Conduct, Coaching Education and Concussion Training Column. As per IAC rule 126-6, a paid coach must possess a valid First Aid and CPR card by the first day of after-school practice. This form, signed by the Principal, must be submitted to the Athletics Office by the first day of practice.
Only those certificated persons who are teaching a physical education class in athletics and do not hold a Physical Education Credential, a General Credential or some other authorized credential to teach Physical Education, need to be reported under S. B. 435.* Some people will be reported in both columns.
Print name and employee number of each coach. Boxes should be checked off to verify they have met the Title V requirement, Coaching Education, Concussion Training requirements and signed the Coaches Code of Conduct. . Only fully credentialed teachers are eligible to obtain a one period coaching authorization to teach physical education during the regular school day, if not credentialed in physical education (SB 435).” Check SB 435 only if the coach is qualified for the teaching credential waiver.
SPORT / NAME / EMPLOYEE # / FIRST AIDCPR / CODE OF CONDUCT / COACHING ED. / CONCUSSION
TRAINING / S.B. 435 / CHILD ABUSE
Basketball, Head Coach M / ______
Expiration Date / met / Date / Expiration Date / need / met
Basketball Asst., JV M / ______
Expiration Date / met / Date / Expiration Date / need / met
Basketball, Head Coach W / ______
Expiration Date / met / Date / Expiration Date / need / met
Basketball Asst., JV W / ______
Expiration Date / met / Date / Expiration Date / need / met
Soccer, Head Coach M / ______
Expiration Date / met / Date / Expiration Date / need / met
Soccer, Asst,. JV M / ______
Expiration Date / met / Date / Expiration Date / need / met
Soccer, Head Coach W / ______
Expiration Date / met / Date / Expiration Date / need / met
Soccer, Asst., JV W / ______
Expiration Date / met / Date / Expiration Date / need / met
Water Polo / ______
Expiration Date / met / Date / Expiration Date / need / met
Wrestling (Boys) / ______
Expiration Date / met / Date / Expiration Date / need / met
Wrestling (Girls) / ______
Expiration Date / met / Date / Expiration Date / need / met
Principal’s SignatureDate______
School
LOS ANGELES UNIFIED SCHOOL DISTRICT
Office of Interscholastic Athletics
EMPLOYMENT OF ATHLETIC ASSISTANT FORM
NOTE: Before completing this form, read attached guidelines for hiring and payroll procedures.
THIS FORM DOES NOT AUTHORIZE EMPLOYMENT. Each person must be processed and approved by Classified Personnel Division and a “greenie” for each position must be created before any time may be reported. This process can only begin when this form is received in the Athletics Office.
The position of “Athletic Assistant” is a classified position and is paid monthly for time reported. Please see page two of this form indicating the maximum number of hours for which an “Athletic Assistant” can be paid for specific coaching assignments. In addition, the number of hours reported is not to exceed 75 hours in any single pay period, except for a Campus Aide’s hours, which may be distributed throughout the school year, not to exceed 799 hours when the total number of hours for the two assignments is combined.
Name of Athletic AssistantPosition to be FilledEmp. No.*Coaches Pay RateEffective DateSchool Location
(See Below) ( Rate # 1-6) Code Needed
1. ______
2. ______
3. ______
4. ______
5.______
______
SchoolPrincipal’s SignatureDate
______
School Payroll Clerk’s SignatureDate
*If the employee number is not yet known, school must indicate “In Process.” This information will be verified with the Classified Personnel Office. The employee number must be submitted to the Athletics Office when it becomes available.
NOTES:1.All newly hired paid coaches must complete the ASEP/CIF Coaching Education and must have
certification of current CPR , First Aid and Concussion Training on file at the school.
2.All Athletic Assistants must be cleared and approved by Classified Personnel in order to begin the assignment.
3.Schools must check with Classified Personnel prior to re-assigning a current or returning employee in order to determine if the employee has satisfied all qualifications for employment.
APPROVED: ______
Director, Interscholastic Athletics Date