Coach Compliance Violation Form/Ethical Violation Form Club Hosting Event Event Type/Location Print Name of Offending Member #: PSA #: Date/Time of Incident Person: ___/___/____ ___:___am pm (please be specific, describe only facts, use back or additional paper if needed.) Description of Offending Behavior: Coaching or attempting to coach without being compliant (one or more of the requirements) Coaching or attempting to with U.S. Figure Skating Membership and/or PSA Membership Improper Use of Credentials (lending or borrowing Coach Credentials) Code of Conduct Violation (please check all the apply) Verbal Altercation Display of Use of Inappropriate Language Display of Inappropriate Gestures Use of Physical Aggression Use of Threatening Language Other (please describe) _____________________________________________________________ Supporting Details (please be specific, describe only facts, use back or additional paper if needed.) Name of Witness(es): U.S. Figure PSA #: Contact #: Email: Skating #: (if applicable) Name of Competition Chair or U.S. Figure PSA #: Contact #: Email: Other Event Official: Skating #: (if applicable) ___/___/____ Signature of Competition Date: Chair or Other Event Official: Signature of Test Chair or Date: ___/___/____ Chief Referee**: ** This report must be signed and submitted by the test chair or chief referee. Please submit to: John Anderson Staff Attorney or – mail to: 20 First Street, Colorado Springs, CO 80906
Coach Compliance Violation Form/Ethical Violation Form Club Hosting Event Event Type/Location Print Name of Offending Person: Member #: PSA #: Date/Time of Incident ___/___/____ ___:___am pm Description of Offending Behavior: (please be specific, describe only facts, use back or additional paper if needed.) Coaching or attempting to coach without being compliant (one or more of the requirements) Coaching or attempting to with U.S. Figure Skating Membership and/or PSA Membership Improper Use of Credentials (lending or borrowing Coach Credentials) Code of Conduct Violation (please check all the apply) Verbal Altercation Display of Use of Inappropriate Language Display of Inappropriate Gestures Use of Physical Aggression Use of Threatening Language Other (please describe) _____________________________________________________________ Supporting Details (please be specific, describe only facts, use back or additional paper if needed.) Name of Witness(es): U.S. Figure Skating #: PSA #: (if applicable) Contact #: Email: Name of Competition Chair or Other Event Official: U.S. Figure Skating #: PSA #: (if applicable) Contact #: Email: Signature of Competition Chair or Other Event Official: Date: ___/___/____ Signature of Test Chair or Chief Referee**: Date: ___/___/____ ** This report must be signed and submitted by the test chair or chief referee. Please submit to: John Anderson – Staff Attorney or mail to: 20 First Street, Colorado Springs, CO 80906
Coaching%20Violation%20Form.docx