Surname*Name*No. StreetMunicipalityP.O. BoxPostal CodePrimary Phone Number*Email* How would you like us to contact you?PhoneEmailNCCP#I am presently an active CoachYesNoYour sportPreferred languageEnglishFrançaisModules Planning a Practice Basic Mental Skills Teaching and Learning Design A Basic Sport Program Coaching and Leading Effectively Psychology of Performance Prevention & Recovery Managing Conflict Developing Athletic Abilities Advanced Practice Planning Performance Planning Manage a Sport Program Please select request home study module(s). * Please note, all home study material will be sent electronically.Payment Method: All payments are to be made via The Locker online registration, please contact Coach NB: email@example.com Circumstances*Please specify your extenuating circumstances leading you to choose the Home Study program Applications cannot be processed until payment has been received; All applications via mail must include payment for courses (cheque or cash); All home studies must be completed and returned within two months of receiving the materials, unless another due date has been decided upon by the coach and Manager of Coach Education; Any extensions must be approved by Coach NB; Refunds will only be given in exceptional circumstances. Please note that it may be subject to a cancellation fee. Upon Approval: All necessary course material including: the Coach Workbook, Reference Book, any relevant links, and Coach Developer contact information will be sent to the Coach, along with instruction on how to proceed and submit the course evaluation. Upon Completion: You will be notified by email or telephone of your results, and your Coach Workbook will be returned to you with comments from the Coach Developer. If you are unsuccessful in the completion of the Home Study module, a $25 re-marking fee may be applied. For any other questions relating to the Home Study program, please contact Coach NB at firstname.lastname@example.org, with the subject line "Home Study Module Application”.