Indigenous Coaches and Officials Program Participant Profile Form

WORKSHOP INFORMATION

Name of Workshop*

Sport*

Please specify the sport this course is for. If for multi-sport, please enter multi-sport.

Course Date*

(mm/dd/yyyy)

Location

Learning Facilitator

PARTICIPANT INFORMATION

Name*

First Last

NCCP #

Address

Street Address City Province Postal Code

Phone

Email*

Birth Date*

(mm/dd/yyyy)

Voluntary Self-Identification

Providing a response to the following statements below is voluntary. Information provided will assist Sask Sport with determining eligibility and will be used in follow-up reporting. All information will be kept confidential and will not be used or shared outside of our organization.

Choose the gender that you identify with:

Female
Male
Non-Binary
Two-Spirit
Self-describe

Prefer to self-describe

Indigenous Descent

First Nations
Métis
Inuit
Self-describe

Indigenous Descent

Treaty Number

First Nation

Métis Number

Métis Local

Email Updates

Would you like to be added to an email list to receive information on upcoming workshops and other Coach Professional Development opportunities?

Yes, I would like to receive email updates.

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