USO Coaches Information Form

Coaches Information
Name*

First NameLast Name
School Name*
Date of Birth *

MonthDayYear
Date
Gender*

WomanManNon-BinaryPrefer not to DisclosePrefer to Self-Describe
Number of Years Teaching*
Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County *
Email*
example@example.com
Phone*
Please enter a valid phone number.
What is your racial identity? (Select all that apply.)*

American Indian or Alaskan NativeAsianBlack or African AmericanNative Hawaiian or Other Pacific IslanderWhiteNone of the above, please specify...
What is your ethnic identity?*

Hispanic, Latino, or Spanish OriginNot Hispanic, Latino or Spanish OriginNone of the above, please specify...
Have you previously attended the State Science Olympiad tournament before?

YesNo
Please list the years you've attended Utah Science Olympiad.*

20192018201720162015201420132012
Will you need any special accomodations during the competition?*

YesNo
If yes, please list any and all accommodations you will need:
Please list any medical problems that you may have in the event you should need emergency medical care (for example, allergic reactions, heart problems, etc.)
Media Release: For value received and without further consideration, I hereby consent that all photographs and/or recorded images taken of me and/or recordings made of my voice and/or written extraction, in whole or in part, of such recordings at the Utah Science Olympiad 2021 by Southern Utah University may be used by the Utah Science Olympiad and/or others with the consent of Utah Science Olympiad for the purpose of illustration, advertising, or publication in any manner.
Media Release: I have read and hereby consent to the terms of the Media Release as describe above.*

Yes
Student Info: I authorize my information listed above and the events I compete in at the State Science Olympiad to be shared with other Utah higher educational institutions participating in the Utah Science Olympiad for the express purpose to receive future communications related to academic programs, opportunities to participate in STEM-related camps and programs, additional scholarship opportunities, and other post-secondary information.
Student Information: I have read and hereby consent to the terms of the release of Student Information as described above.*

Yes
Science Olympiad Code of Ethics: I have read and hereby consent to the terms on the National Science Olympiad website as described above.*

Yes
Coach Signature*

Clear
Should be Empty: