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Athletic Excellence Grant Application

Applications should include this information

Updated 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:          

          Name(s):_____________________________________________________         

          Phone Number(s):  _____________________________________________         

          Email(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): _______________________________________________

Email(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.

ANNUAL INCOME:

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:

  •  the local minor sports group (and/or current one if involvement is now outside the local area),
  •  the governing provincial sport organization and
  •  the governing national sport association.

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.

 




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