Fillable Southampton Talented Athlete Scheme Application Form (Southampton Solent University)

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Southampton Talented Athlete Scheme Application Form (Southampton Solent University)

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2015/2016
SOUTHAMPTON
TALENTED ATHLETE SCHEME
APPLICATION FORM
Southampton Solent University provides a vast range of services to help Southampton’s most talented
athletes to reach their potential.
How to Apply
1. Eligibility
• Must be a resident of Southampton.
• Aged between 12-18 years.
• At least National and or International rankings.
• Top 20 ranking within age group.
• Competing within UK Sport and Sport England recognised sports.*
• Planning to study within Higher Education.
2. Please complete all sections electronically, ensuring you sign the
form, and email it to high.performance@solent.ac.uk.
Alternatively, you can print the application and send it by post to the
address on the last page.
3. Collect evidence from National Governing Body and Coach
to prove your competitive performance level.
Evidence:
• National Governing Body website information
• Competition and result standings
• Letters of invitation to national team squads
• Coaches Testimonial.
Selection Criteria
Numerous factors will determine the level of support provided to an athlete. These include; national and
international rankings, competition results and selection for national and international teams.
The selection panel will consider the athletes current position on the performance pathway towards senior
world class competitions (Olympics, Paralympics and World Championships).
Athletes who are competing or are near to these competitions will be provided more support.
*Sports which are not UK Sport and Sport England recognised will not be eligible.
Services Provided
Support services begin from a county level and continue through to internationally competing athletes.
Due to the variety of National Governing Bodies (NGB’s) pathways the athletes, your NGB may be
consulted to insure appropriate support is provided at the correct level.
Athlete
Development
Workshops
Free
Southampton
Bus Pass
Free Access
to Sports
Facilities
Discounted
Products
Physiotherapy
Strength and
Conditioning
INDIVIDUAL PERFORMANCE
Title
Mr
Mrs
Miss
Ms
Other (please state)
Full Name
Date of Birth Age (as of 1/1/15)
Address
Postcode
Contact Number
Email Address
Sport (including discipline)
School / College (if studying)
Coaches Name
Coaches Email Address
How did you find out about
the service?
ANNUAL EXPENSES
Travel £ Club Fees £
Coaching £ Equipment £
Competition £ Other £
TOTAL £
ADDITIONAL SUPPORT
If you receive any additional funding please state the name and details of the organisation (s) and the amount given.
Name
Address
Postcode
Awarded Amount £
INDIVIDUAL PERFORMANCE
Please list your most successful national and international competition results from the last two Years (24 months)
Evidence of performance must be provided.
Name of Event Date attended Position/result Position/year before
TEAM PERFORMANCE
Please list all national and international performances from the last two years (24 months)
Evidence of performance must be provided
SUPPORTING STATEMENT
Please give details of your aspirations over the next year and specific targets (including dates of trials etc , where relevant) for
this sporting season and also a brief idea of your long term aims.
*Please attach coach testimonial on a separate document when sending this application.
BUS PASS
Would you like to be considered for a free First Bus Pass?
*Only Southampton routes will be available.
Yes
No
PHOTO CONSENT
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?
Yes
No
May we use your image on our website?
Yes
No
May we include your name and sport on the list we supply to
selected media contact within the local region for promotion-
al purposes?
Yes
No
May we use your image to promote the Southampton Talent-
ed Athlete Scheme?
Yes
No
DECLARATION
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.
Applicants Signature
Date
Parental Consent (if the applicant is under18):
Parent/Guardian Name
Signature
Date
THE CLOSING DATE IS 13/11/15. Please ensure our High Performance team receives your application before this date.
TERMS AND CONDITIONS
If you are successfully awarded the Southampton Talented Athlete Scheme you agree to:
1. Complete a STAS questionnaire and provide an electronic photo which will be used to create a profile of you that will be
used on the Solent Sport website.
2. In the event of winning a medal at an event, you agree to reference support from Southampton Solent University and
Southampton City Council.
3. To be available for any personal appearances that seem sufficient by Southampton Solent University or the Southampton
City Council (maximum of 3) this may include: awards evenings, school based visits and community sports events.
4. Personal information to be shared with key service providers in administering support within Southampton.
5. All decisions and extra awards are at the discretion of the selection.
CONTACT INFORMATION
On completion of the application two options are available:
Please print, sign and post to:
Solent Sport
Southampton Talented Athlete Scheme
Southampton Solent University
East Park Terrace
Southampton
SO14 0YN
Upon completion of the application, please click the email
below and send this application along with any other
supporting documents to:
High.Performance@solent.ac.uk
Please title the email:
Southampton Talented Athlete (Insert your name here)
Please note, you will receive a confirmation email.
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Southampton Talented Athlete Scheme Application Form (Southampton Solent University)

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Completed 25 July 2020

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