Athletic Excellence Grant Application
Applications should include this informationUpdated Saturday October 20, 2018 by Kitchener Sports Association.
Kitchener Sports Association: Athletic Excellence Application
Submit to: KSA Athletic Excellence, 92 Sherwood Ave., Kitchener, Ont., N2B 1J9
SECTION A: Personal information (include the following):
1. First Name: _______________________ Surname: ____________________
2. Telephone: Home _____ - ______________ Cell _____ -______________
3. Email address: __________________________________________________
4. Date of Birth: Month _______ Day _______Year ___________
5. Local address: ___________________________________________________
6. Current address (if different from above –and reasons why): _______________
7. Parents Contact Information:
Phone Number(s): _____________________________________________
8. School/grade/course: ____________________________________________
SECTION B: Athletic profile information (include, as appropriate):
1. Sport: ___________________________ Event(s): _____________________
2. Main training city & facilities: ______________________________________
3. List of major athletic accomplishments realized in career to date:
4. Current competition level: ________________________________________
Ranking: Individual ______ Team (if applicable) ______
5. Coach’s name(s): _______________________________________________
6. Are you carded? □ Yes □ No If YES, what level? __________
SECTION C: Financial information (Last year’s actual figures – with list of events - and budget for this (upcoming/current) year.
Work: Net annual income $ _____________________
School: Grants, scholarships $ _____________________
Sponsorships: (specify) _________________________ $ _____________________
Carding: Senior / Development $ _____________________
Bonuses: Prize money, competitions, other $ _____________________
Fundraising efforts: $_____________________
Other: (please specify) _________________________ $_____________________
Appearance/speaking fees, etc.
TOTAL ANNUAL INCOME $ _____________________
ATHLETIC EXPENSES: Show (and note) any expenses covered by your sports federation or your sports club but only portion you are personally responsible for gets included in total.
Travel: (Itemize by trip as appropriate) $ _____________________
Accommodation: (Itemize by trip as appropriate) $ _____________________
Coaching: $ _____________________
Club/team fees: $ _____________________
National team fees: $ _____________________
Equipment: $ _____________________
Other: (please specify) ______________________ $ _____________________
TOTAL ANNUAL EXPENSES $ _____________________
NET INCOME (annual income minus annual expenses) $ _____________________
SECTION D: Letters of support from:
SECTION E: Covering letter, certification and agreement:
The application needs to include a signed covering letter including the following statements (or similar to the same effect):
I certify that all information given in this application is complete and true. I will notify the Kitchener Sports Association (KSA) of any change to this information as contained herein. I authorize KSA to verify any information contained in this application.
Furthermore, I agree to have my name, photo and/or likeness used by KSA in promotional materials, on the KSA website and in media materials (print, television, radio) highlighting the grant and/or KSA Athletic Excellence Program.
Include any further material you deem appropriate to support your request.