Longevity Form

Longevity Awards Form 2018-19

MCA Longevity Awards are designed to recognize athletic coaches, AD's and trainers for years of active service.

If you are eligible for a Longevity Award (first awarded at 15 years of service and then in 5 year increments), please submit the following form. Please indicate the total number of years (through May 2019) that you have served as coach, AD, trainer or combination thereof, on the line provided.

Awards are not made retroactively. If you have coached 33 years, for example, and have never sent in a longevity form before, you are only eligible for a 30-year award, not 15, 20, and 25 also.

You must have coached and/or been an AD or trainer in Montana during this school year, and at least 5 years of service must have been in Montana. RETURN BY 6/15/19.

Name*
First Last
Email*

Address*
Mailing address City State ZIP Code

Home Phone*
School*
Longevity Award*
(starting year listed in parenthesis)
1st Year Of Service*
Select school year
Total # of Years*
as Coach, AD or Trainer - please indicate the total number of years, through May 2019, that you have served as an athletic coach, AD, trainer (or combination thereof), on the line provided.
Years Missed
(if any)
15 and 20 year qualifiers: Would you like to upgrade to a plaque for $15?*
Qualifiers automatically will receive a certificate. 15 year and 20 year have the option to upgrade to a plaque if they choose to do so.
Yes
No
Cost to upgrade to a plaque
Price: $15.00
Will you be attending the Awards Ceremony on Thursday, August 1st, 2019 at 11:30 AM in the CMR High Auditorium in Great Falls?*
Yes
No
How will you collect your plaque?*
I will have a friend pick it up at the awards ceremony (preferred)
Please ship it to me for a $10 shipping and handling fee
Shipping and Handling Fee
Price: $10.00
Total
$0.00
How will you pay for your fees?*
Online
Mail
Mailing Address
Payable to:
MCA
375 Ramble Inn Rd.
Fort Shaw, MT 59443

Save and Continue Later