Would you like to be considered for a free First Bus Pass?
*Only Southampton routes will be available.
Throughout your time on the scheme, Southampton Solent University, Southampton City Council and other partners
may wish to take photographs for promotional purposes. Images may appear in printed publications, websites and local
press. To comply with Data Protection Act 1998, your permission must be granted before we take any photographs.
Please answer below accordingly.
May we use your image in printed publications produced by
Southampton Solent University/ Southampton City Council
and its partners/sponsors for promotional purposes?
May we use your image on our website?
May we include your name and sport on the list we supply to
selected media contact within the local region for promotion-
May we use your image to promote the Southampton Talent-
ed Athlete Scheme?
To the best of my knowledge, the details in this application are correct. By signing this form I agree that I will abide by the
terms and conditions as stated below and understand that information from this form may be used for administration
purposes in accordance with the Data Protection Act 1998.
How the information about you will be used:
• We will use your information to process your grant application
• If you have requested support services, we will share your information with key service
providers who support the scheme. Providers include leisure centres, physiotherapists, bus
company and Southampton City Council Education Service.
• We will also need to share your information with National Governing Bodies of sport, to verify
your performance and our local authority partners.
Information will be kept securely stored and deleted ﬁve years after your last participation.
Please print the form and then sign below.
Parental Consent (if the applicant is under18):
THE CLOSING DATE IS 13/11/15. Please ensure our High Performance team receives your application before this date.