Why not help in the advancement of our sport? MENTOR!
Print this page and mail to address at bottom.
ITCCOA Mentoring Program Application
Applicant’s Name Date
Address
City State Zip
Home Phone Work Phone
E-Mail IHSA Officials Number
Signed
Supervising Officials Information
Name IHSA Number
Address
City State Zip
Home Phone Work Phone
E-Mail IHSA Official for Years
( Seven (7) years minimum required)
Officials
Signature
Return To:
Glenn Cothern
1037 E. 500 N. Road
Gibson City, IL 60936