UCI Coach Development Programme

Course Application Form and Coach Profile

To attend the Coach Development Programme please complete this form and return it together with the relevant paperwork to the address overleaf. If you need help and advice before you make a booking, please contact the Development Department (). This information will be used to register you onto the programme. The information will also be shared with the programme trainers and World Cycling Centre Coaches / Mechanics to enable them to provide a quality delivery and support for all coaches on the course.

Course Details (please indicate below which course you wish to attend)

Course / Dates / Course / Language / Cost / Selected course
Course 1 / 3rd to 17th March 2018 / Coaching level 1 & 2 including mechanics level 1 / English / CHF 2500.00
Course 2 / 17th July to 10th August 2018 / Level 3 Diploma / English / CHF 5000.00
Course 3 / 15th to 26th October 2018 / Coaching level 1 & 2 including mechanics level 1 / English / CHF 2500.00

Personal Details

Title: First Name: Surname:

Maiden Name:

(for women) Gender: Female Male

Date of Birth:

Nationality: Religion:

Postal Address:

Postcode: City: Country:

Tel no. (home): Tel no. (work): Contact in case of emergency:

Mobile: E-mail: Name:

Phone no.:

Contact telephone number – you must provide at least one contact number, preferably a number that you can be contacted on during the day.

Important: please send us a copy of your passport!

Passport-No:

Date of issue: Valid until:

Excellent
1 / 2 / 3 / 4 / Poor
5
Spoken
Written
Reading

Level of English knowledge:

Mother tongue:

Coach Profile

Please complete the following questions to help us to maximise your education experience. This information will be shared with the course trainer and WCC Coaches / Mechanics, to enable them to provide a quality delivery and support for all candidates on the course.

Briefly outline your coaching history/experience

Give a brief summary of your cycling experience

List any other cycling courses / qualifications held (please attach copy of certificates)

List any other relevant courses / certificates or qualifications, (eg teaching, other sport coaching qualifications)

My current coaching activities are:

My future coaching activities are likely to be:

My cycling specialisation is (discipline):

Why do you want to attend the Coach Development Programme?

Any other information you feel we should know (including any specific dietary requirements)?

Prerequisite Documentation

I have attached the following compulsory documentation. I understand that my application will not be processed without these documents.

Copy of your passport

Copy of your certificates

A letter of approval from your National Federation (mandatory)

Have you secured funding for the course fees? Yes No

Please provide contact details for the above, for invoicing of course fees:

Place and date: Signature:

Please return this application form and prerequisite documentation to: 2/3