2018 BETTE ALLISON TARGETED COACH
REGIONAL SCHOLARSHIP APPLICATION FORM
Please complete all components of the application form. Incomplete applications will not be considered.
Coaches Details
Applicants Full Name: Click or tap here to enter text.
Address: Click or tap here to enter text.
Postal Address: Click or tap here to enter text.
Home Phone: Click or tap here to enter text. Mobile: Click or tap here to enter text.
Email: Click or tap here to enter text.
My Netball Number:Click or tap here to enter text. Region: Choose an item.
Association: Click or tap here to enter text. Club: Click or tap here to enter text.
Coaching Information:
Coaching Level: Choose an item.Year Attained: Click or tap here to enter text.
Please indicate how long have you been coaching: Click or tap here to enter text.
What other qualifications / courses have you attended related to coaching? (Include
course dates):
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Please indicate what level of athletes you are presently coaching:
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Describe your involvement in the team indicated above and length of time of your
involvement:
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What are your coaching goals long and short term?
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If you were successful in obtaining the Regional Scholarship, what strategies would you implement to increase your coaching skills?
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Do you derive an income from coaching? Click or tap here to enter text.
Privacy Statement and Statement of Disclosure
The Organisation acknowledges and agrees that this Agreement and information
regarding it is subject to the Freedom of Information Act 1992 and that the Grantor may
publicly disclose information in relation to this Agreement, including its terms and details of
the Organisation.
You can access any information provided by you to Netball WA during standard office hours
and updated in writing to Netball WA. All information provided on this form and gathered
throughout the assessment process will be stored on a database that will only be accessed
by authorised departmental personnel and is subject to privacy restrictions.
Netball WA may wish to provide certain information to the media for promotional purposes.
The information will only include the applicants club, association, and region location and
grant purpose.
Declaration by applicant
I hereby certify that to the best of my knowledge, the information given above and any other supporting documentation is correct.
I acknowledge that the scholarship support places obligations on myself, which I agree to meet, acknowledging that failure to meet these obligations might place funding in jeopardy. They also include the obligation to submit a Program Review Report and refund scholarship funds not spent on activities approved by Netball WA.
Name: Click or tap here to enter text.
Signature:
Date: Click or tap here to enter text.
If you have any queries about your eligibility or the details required when applying for this grant, please contact Liz Chetkovich, Manager – Netball WA Community Netball Department
Endorsement of Region
I Click or tap here to enter text. as a representative ofChoose an item.
holding the position ofClick or tap here to enter text. support this application for the Bette Allison Targeted Coach Regional Coaching Scholarship and commit to supporting the applicants coaching plan.
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Bette Allison Targeted Coaching Scholarship – Regional
Statement of Ability
(To be completed by Region/Association/Club, Coaching Development Coordinator or President)
As a person that knows the coaching ability of the applicant for the Regional Scholarship it would be appreciated if you could provide information under the following headings.
What is your relationship to the coach?
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How long have you known the coach? Click or tap here to enter text.
Planning (i.e. Does the coach plan well? Is there evidence of a long-term planning for athlete development? It detailed planning evident in training sessions?)
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Technical Knowledge (i.e. Does the coach have sound netball technical knowledge? How has this been developed?)
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Management of Athletes (i.e. Does the coach display competency around athlete management? How is this shown?)
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Management of Support Staff (i.e. Does the coach display a level of understanding in managing staff around them? How is this shown?)
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Relationship Building (i.e. Does the coach have the ability to develop positive relationships with those around them?)
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Self-Development (i.e. Does the coach have a personal development plan? Does the coach take responsibility for his or her own development?)
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The above information is true and correct to the best of my knowledge and I am willing to be contacted by Netball WA for further information as required.
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