NEXT GEN ATHLETE GRANT AND SCHOLARSHIP APPLICATION FORM

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1 NEXT GEN ATHLETE GRANT AND SCHOLARSHIP APPLICATION FORM An initiative of Sport Inclusion Australia GENERAL FIRST SUR SEX: M F DOB: STREET ADDRESS: SUBURB: CONTACT PHONE: (H) POSTCODE: (M) DO YOU CURRENTLY ATTEND SCHOOL: (Y) (N) IF YES: NAME OF SCHOOL: SCHOOL YEAR: DO YOU IDENTIFY AS ANY OF THE FOLLOWING: ABORIGINAL TORRES STRAIT ISLANDER CALD (Cultural and Linguistically Diverse background) DO YOU HAVE A SPORT INCLUSION AUSTRALIA REGISTRATION NUMBER (AUSRAPID NUMBER) (Y) NUMBER: (N) Note: All grantees will be required to register with Sport Inclusion Australia. Please contact Life Stream Australia for details on eligibility and forms for registration/classification. Applicants must advise their Sport Inclusion Australia (AUSRAPID) registration number prior to the close of applications for each round, to be eligible.

2 SPORT The NEXT GEN ATHLETE Grants and Scholarships are targetted at athletes who have potential to compete at representative levels across the 9 sports offered as part of the Inas Global Games Event Program. The list of eligible sports is subject to change without notice. Athletes who do not identify with these 9 sports are welcome to still apply and indicate which sport they would like to receive support with in the other please specify box. Applicants should however note that priority for funding will be given to athletes nominating from one of the Inas Global Games sports listed. SELECT PRIMARY SPORT FOR WHICH YOU ARE SEEKING SUPPORT: ATHLETICS BASKETBALL CYCLING FUTSAL ROWING SWIMMING TABLE TENNIS TENNIS TAEKWONDO - Poomsae OTHER PLEASE SPECIFY: ATHLETIC ACHIEVEMENTS / REPRESENTATIVE LEVELS The below section is about the details of your achievements to date. An additional text box has also been provided for you to give us any further details. REPRESENTED SCHOOL AND ZONE CHAMPIONSHIPS - DETAILS REPRESENTED ZONE AT REGIONAL CHAMPIONSHIPS - REPRESENTED REGION AT STATE CHAMPIONSHIPS -

3 REPRESENTED STATE AT NATIONAL CHAMPIONSHIPS - REPRESENTED COUNTRY AT INTERNATIONAL EVENT - OTHER AWARDS/ACHIEVEMENTS/RECORDS PLEASE USE THIS SPACE TO PROVIDE US WITH ANY FURTHER INFORMATION IN SUPPORT OF YOUR APPLICATION STATE SPORT ORGANISATION / SCHOOL SPORT VERIFICATION Please provide the following details. This person will be contacted to verify athletic achievements / membership of development squads etc. POSITION: CONTACT CONTACT PHONE:

4 WHAT A NEXT GEN GRANT OR SCHOLARSHIP WILL MEAN TO ME AS AN ATHLETE IN 50 WORDS OR LESS TELL US WHAT RECEIVING A GRANT OR SCHOLARSHIP WOULD MEAN TO YOU AS AN ATHLETE. To the best of my knowledge the information provided on the form is correct. I have read the terms and conditions of the NEXT GEN ATHLETE Grants and Scholarships Program and accept all of these terms and conditions. The decision of the NEXT GEN ATHLETE grants and Scholarships selection panel is final and no correspondence will be entered into as a result of not being selected. Applicants who are unsuccessful with their application in any round are eligible to apply in further rounds. I give approval for any officer of Sport Inclusion Australia to verify any or all of the details contained within this form with my school, local club or state sporting organisation as part of the selection process if required. A parent/legal guardian must sign all applications for athletes under 18. Contact details for parent/legal guardian for applicant under 18 years of age: SUR FIRST RELATIONSHIP TO APPLICANT: CONTACT PHONE NUMBER: CONTACT STATEMENT - I I AM THE PARENT/LEGAL GUARDIAN OF GIVEN PERMISSION. AM OVER 18 YEARS OF AGE. FOR ONLINE APPLICANTS: completed applications along with any attachments to nga@sportinclusionaustralia.org.au ALL OTHER APPLICANTS: Print, scan and forms to nga@sportinclusionaustralia.org.au.

5 OFFICE USE ONLY DATE RECEIVED: REFERENCE NUMBER: REFERENCE NUMBER: PRIMARY ELIGIBILITY CHECKED SHORTLISTED PANEL REVIEW RANKING: OUTCOME OF APPLICATION GRANT/ SCHOLARSHIP OFFERED: DECISION: ADMINISTRATION SENT