Highest tests passed by student:
Select Discipline Figures Free Skating Dance Free Dance Pairs Team Moves in the Field	Name: Phone:
	Test:
Select Discipline Figures Free Skating Dance Free Dance Pairs Team Moves in the Field	Name: Phone:
	Test:
Select Discipline Figures Free Skating Dance Free Dance Pairs Team Moves in the Field	Name: Phone:
	Test:
Complete the following if applying for FS, MIF, Dance, FD, or Pairs:
Teaching experience: I certify that I have taught an average of hours per year for years at the following location: .
Complete the following if applying for Group:
Teaching experience: I certify that I have taught an average of hours per year for years at the following location: .
Supervisor:
Complete the following if applying for Synchronized Team:
Teaching experience: I certify that I have taught an average of hours per year for years at the following location: .
Name of Team: Competition level attained: Date: Placement:
Supervisor:
Complete the following if applying for Program Director:
Teaching experience: I certify that I have held the position of for years at the following location: .
Supervisor/Rink Manager/Owner:
Complete the following if applying for Choreography & Style:
Teaching experience: I certify that I have choreographed an average of hours per year for years at the following location: .
-OR-
Dance experience: I certify that I have taken at the level from: .
RESUME SECTION - REQUIRED
SUMMARY OF SKILLS
Skating background, tests, etc.
PSA Ratings and/or Rankings currently held
Other professional training (first aid, pilates, time management, etc.)
EDUCATION
Level and additional courses
CAREER EXPERIENCE
Coaching employment history (past five years; dates & location)
Present coaching situation (disciplines, hours, etc.)
Other (ice show, dance, theatre, etc.)
YOUR COACHES
Please list
Applications must be submitted to the PSA office at least 60 days prior to the date of the exam or by the published deadline. Late applications are accepted at the discretion of the Rating Chairman. If accepted, a 50% late fee is charged.
I understand any misstatement or untruthfulness may result in my rating being disallowed. I am a full member in good standing of the Professional Skaters Association. The above information is true and accurate to the best of my knowledge.
PSA Cancellation Policy 30 days or more: 50% refund; less than 30 days: NO REFUND. Please review all information carefully.
I have read & accept the above terms.