LAUSD Office of Interscholastic Athletics
WINTER SUPPLEMENTAL COACHING ASSIGNMENTS
Year________________
Name
(Last, First, M. Init.)
Employee
Number
Status
(AA, Perm, LTS)
1. BASKETBALL, Varsity M
Rate 6, $2,512 (Wage Type: 1407)
Home Address
SS #
Telephone
(
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Telephone
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Telephone
(
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Telephone
(
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Telephone
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Telephone
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E-Mail Address
2. BASKETBALL, M/JV
Rate 3, $1,691 (Wage Type: 1402)
Home Address
SS #
E-Mail Address
3. BASKETBALL, Varsity W
Rate 6, $2,512 (Wage Type: 1407)
Home Address
SS #
E-Mail Address
4. BASKETBALL, W/JV
Rate 3, $1,691 (Wage Type: 1402)
Home Address
SS #
E-Mail Address
5. SOCCER, Head M
Rate 6, $2,512 (Wage Type: 1407)
Home Address
SS #
E-Mail Address
6. SOCCER, Asst. M/JV
Rate 3, $1,691 (Wage Type: 1402)
Home Address
SS #
E-Mail Address
Name
(Last, First, M. Init.)
Employee
Number
Status
(AA, Perm, LTS)
7. SOCCER, Varsity W
Rate 6, $2,512 (Wage Type: 1407)
Home Address
SS #
Telephone
(
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Telephone
(
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Telephone
(
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Telephone
(
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Telephone
(
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E-Mail Address
8. SOCCER, W/JV
Rate 3, $1,691 (Wage Type: 1402)
Home Address
SS #
E-Mail Address
9. WATER POLO W
Rate 4, $2,102 (Wage Type: 1403)
Home Address
SS #
E-Mail Address
10. ***WRESTLING BOYS
Rate 4, $2,102 (Wage Type: 1403)
Home Address
SS #
E-Mail Address
11. ***WRESTLING GIRLS
Rate 4, $2,102 (Wage Type: 1403)
Home Address
SS #
E-Mail Address
***For a school to receive both Wrestling stipends, minimum of at least 10 wrestlers of each gender must participate throughout the
entire season. If not, only one stipend will be provided for Wrestling.
CHECKLIST
I have attached the “Employment of Athletic Assistant Form” for all non-certificated coaches and
“Freeze Exemption Form” (if it applies).
I have answered the Coaching Education information for each coach.
I have written the word “None” or DNF in any assignment for which we do not field a team.
I have included and completed the Title V, S.B. 435 Certification and Coaching Ed. requirement.
I certify all of the above paid coaches are 21 years old or older prior to starting their coaching
assignment.
No amendments will be allowed to a coaching position assignment after the 5 th week of a sport
except when approved by LAUSD Athletics Office.
SCHOOL:
LOCATION CODE:
ADMINISTRATOR’S NAME:
TITLE:
(please print)
ADMINISTRATOR’S SIGNATURE:
ATHLETICS OFFICE FAX: 213-241-5846
DATE:
LAUSD Interscholastic Athletics Office
WINTER SPORT SEASON
Title V, S.B. 435 Certification and Coaching Education Requirement
Each Season, we are required to verify that all paid athletic coaches meet the Coaches Education Requirement, Title V of the Education Code, and in
many cases, the provisions outlined in S.B. 435. Reporting will be done on a single form, rather than a separate sheet for each.
Each local school site must keep copies of the verifying documents:
1. A valid and current First Aid and CPR card on file - to fulfill the Title V requirement.
2. A certificate on file that verifies successful completion with a passing score on the coaching principles and concussion training.
Each paid coach, whether certificated or an Athletic Assistant must be reported under the Title V, Code of Conduct, Coaching Education and
Concussion Training Column. As per IAC rule 126-6, a paid coach must possess a valid First Aid and CPR card by the first day of after-school practice.
This form, signed by the Principal, must be submitted to the Athletics Office by the first day of practice.
Only those certificated persons who are teaching a physical education class in athletics and do not hold a Physical Education Credential, a General
Credential or some other authorized credential to teach Physical Education, need to be reported under S. B. 435.* Some people will be reported in
both columns.
Print name and employee number of each coach. Boxes should be checked off to verify they have met the Title V requirement, Coaching Education,
Concussion Training requirements and signed the Coaches Code of Conduct. . Only fully credentialed teachers are eligible to obtain a one period
coaching authorization to teach physical education during the regular school day, if not credentialed in physical education (SB 435).” Check SB 435 only
if the coach is qualified for the teaching credential waiver.
EMPLOYEE #
FIRST AID
CODE OF
COACHIN
CONCUSSION
S.B. 435
CHILD
SPORT
NAME
CONDUCT
G ED.
ABUSE
CPR
TRAINING
Basketball, Head Coach M
________
 met
Expiration
Date
Basketball Asst., JV M
________
Date
Basketball, Head Coach W
________
Date
Basketball Asst., JV W
________
Date
Soccer, Head Coach M
________
Date
Soccer, Asst,. JV M
________
Date
Soccer, Head Coach W
________
Date
Soccer, Asst., JV W
________
Date
Water Polo
________
Date
Wrestling (Boys)
________
Date
Wrestling (Girls)
________
Expiration
Date
Principal’s Signature
School
Date
 need
 met
 need
 met
 need
 met
 need
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 need
 met
 need
 met
Expiration Date
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Date
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Expiration Date
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Expiration
Date
 need
Expiration Date
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Expiration
Date
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Expiration Date
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Expiration
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Expiration
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 need
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 met
Expiration
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 met
Expiration
Date
 need
Expiration Date
Date________________
LOS ANGELES UNIFIED SCHOOL DISTRICT
Office of Interscholastic Athletics
EMPLOYMENT OF ATHLETIC ASSISTANT FORM
NOTE: Before completing this form, read attached guidelines for hiring and payroll procedures.
THIS FORM DOES NOT AUTHORIZE EMPLOYMENT. Each person must be processed and approved by
Classified Personnel Division and a “greenie” for each position must be created before any time may be
reported. This process can only begin when this form is received in the Athletics Office.
The position of “Athletic Assistant” is a classified position and is paid monthly for time reported. Please see
page two of this form indicating the maximum number of hours for which an “Athletic Assistant” can be paid for
specific coaching assignments. In addition, the number of hours reported is not to exceed 75 hours in any
single pay period, except for a Campus Aide’s hours, which may be distributed throughout the school year, not
to exceed 799 hours when the total number of hours for the two assignments is combined.
Name of Athletic Assistant
Position to be Filled
Emp. No.*
(See Below)
Coaches Pay Rate
( Rate # 1-6)
Effective Date School Location
Code Needed
1. _______________________
_________________
____________
_________________
___________ _______________
2. _______________________
_________________
____________
_________________
___________ _______________
3. _______________________
_________________
____________
_________________
___________ _______________
4. _______________________
_________________
____________
_________________
___________ _______________
5._______________________
_________________
____________
_________________
___________ _______________
____________________________________
School
______________________________________
Principal’s Signature
____________________
Date
______________________________________
School Payroll Clerk’s Signature
____________________
Date
* If the employee number is not yet known, school must indicate “In Process.” This information will be verified with the
Classified Personnel Office. The employee number must be submitted to the Athletics Office when it becomes
available.
NOTES: 1. All newly hired paid coaches must complete the ASEP/CIF Coaching Education and must have
certification of current CPR , First Aid and Concussion Training on file at the school.
2. All Athletic Assistants must be cleared and approved by Classified Personnel in order to begin the
assignment.
3. Schools must check with Classified Personnel prior to re-assigning a current or returning employee in order
to determine if the employee has satisfied all qualifications for employment.
APPROVED: __________________________________________
Coordinator, Interscholastic Athletics
_______________________
Date