MADISON PUBLIC SCHOOLS
MADISON, NJ
APPLICATION FOR EXTRA-CURRICULAR ACTIVITY POSITION
TO THE APPLICANT: Please complete the information requested.
Name: ___________________________________________________________
Current Employer:_________________________________________________
If NOT a Madison Public School employee, please attach the following:
Teaching Certificate or Current Substitute Certificate
Verification of Mantoux Immunization
Verification of Fingerprinting – Approval Letter
Extra-Curricular Position: ____________________________________________
School Location of Position: __________________________________________
Duration of Position (during the school year): ______________________________
Prior Experience (experience relating ONLY to extra-curricular position):
Years
Experience
Date (s)
Location
(School/Other)
Position
Held
___________________________________________________________________________
Employee Signature
Date
---------------------------------------------------------------------------------------------------------------Director of Student Activities/Student Athletics & School Principals: When
nominating an individual for an ECA (extra-curricular activity), please complete the information
requested. Years experience should be for ONLY the individual sport (i.e., prior football coaching
experience for football ECA) NOT a total of all athletic experience. Placement on the guide should be
calculated on prior school experience.
_________________________________________________________________________________
Director of Student Activities or Director of Student Athletics
Date
Placement on the ECA Guide:
STEP ______________________________
_________________________________________________________________________________
Principal Signature
Date
Return to Personnel Office