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 languageEnglishFrançaisI would like to receive my home study material as aHard Copy*Electronic Fillable Document*Please note that it may take between one to two weeks to receive a hard copy of the home study documentsPer Module Make Ethical Decisions $75 Planning a Practice $75 Design a Basic Sport Program $75 Basic Mental Skills $75 Teaching and Learning $75 Psychology of Performance $100 Leading a Drug Free Sport $100 Prevention and Recovery $100 Coaching and Leading Effective $100 Managing Conflict $100 Developing Athletic Abilities $100 Payment Method: To pay by cheque or cash, please include with mailed application. Cheque made payable to Coach New Brunswick; To pay by credit card via The Locker online registration, please contact Coach NB: firstname.lastname@example.org 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 email@example.com, with the subject line "Home Study Module Application”.