NAME: __________________________________

STREET ADDRESS: __________________________________

___________________________________

CITY: ___________________________________

CONTACT NUMBERS (Please check box for preferred contact number)

Home: _____________________________

Cell: _____________________________

EMAIL ADDRESS(ES) (Please check box for preferred email)

Home: ______________________________

Work: ______________________________

DESIRED POSITION: (CIRCLE) HEAD COACH ASSISTANT COACH

AGE PREFERENCE: (CIRCLE) 9 10 11 12 13 14 15 NO PREF

GENDER PREFERENCE: (CIRCLE) BOYS GIRLS NO PREF

AVAILABILITY: (CIRCLE) SPRING SUMMER FALL WINTER

COACHING EXPERIENCE: (Please list all)

SEASON Age/Gender Group Division Position

(as applicable) (Head or Asst.)

HIGHLIGHTS:

Please provide any additional information you may feel relevant. These may include sports camp work, awards, and potentially your own playing experience. Please provide the relevant years or seasons as they apply to the items you may list. Burke Basketball leadership or volunteer positions should also be included.

Please forward your completed resume to:

Burke Basketball Travel Commissioner Dave Baciocco (bacioccod@saic.com)

Applications will be reviewed by the Burke Basketball Travel Board.

Burke Basketball appreciates your support of our youth programs.