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ACTIVE SPORTS SCHOLARSHIP APPLICATION FORM
 
Personal Details
 
Name                ...........................................................................................................
 
Address            ...........................................................................................................
 
                       ...........................................................................................................
 
                       ...........................................................................................................
 
Post Code         ....................................
 
Telephone Number            Work ..............................     Home .....................................
 
Existing coaching qualification(s) ...................................................................................
 
Do you have a disability?             Yes/No       
 
If yes please give details:
 
..................................................................................................................................
 
..................................................................................................................................
 
Ethnic Origin            Bangladeshi      o            Pakistani  o       Black Caribbean  o
                                 Black African     o            Black Other   o            Chinese   o     
                                  Indian   o       White   o        
 
Course Details
 
Course Title             ...................................................................................
 
Course Start Date     .........................            Course finish date    ............................
 
Course Organiser     .........................            Tel. No. ................................................
 
Course Venue           ..................................................................................................
 
Course Cost               ................................
 
Scholarship amount applied for £ ________  Percentage of course cost ______%
 
Your Coaching Experience
 
What is your current sports coaching experience?   
 
...................................................................................................................................
 
What is the age of the young people you currently work with?
 
...................................................................................................................................
 
What sports club are you principally involved with?
 
..................................................................................................................................
 
Club secretaries name ..............................      Tel No.  ...........................................
 
(club secretaries may be contacted)
 
Signed    .................................              Date      .....................................
 
 
Noel Haines, Senior Active Sports Officer

 Leicestershire, Leicester and Rutland, Active Sports Partnership, C/o Saffron Lane Sports Stadium, Saffron Lane, Leicester, LE2 7NQ

 
 
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