Aylesbury Vale Sport and Physical Activity Network
Sports Coach Grant Application Form
1. Your personal details
This information will be used to monitor our Equalities policy and will not affect the funding decision.
Forename(s): Surname:
Age: 16-18 19-29 30-49 50+ / Gender: Male Female
Do you consider yourself to have a disability: Yes No
If Yes, please inform us of what disability you have:
Employment Status: Employed Self Employed
Part Time (1–16 hours per week) Part Time (17–34 hours per week) Full Time (35+ hours/week)
Number of coaching hours currently delivered per week:Voluntary: Paid:
2. Your contact details
Home Address / Telephone & Email
Post Code: / Home:
Mobile:
Email Address:
3. Coaching Qualification Course Details
You can apply for funding for up to 75% of the course cost, up to the maximum levels shown below.
Course Title: / Course Venue:
Address:
Postcode:
Level 1 (max. £200 can be applied for)
Level 2 (max. £300 can be applied for)
Level 3 (max. £500 can be applied for)
Course Cost: £ / Course Dates: Start Finish
Bursary Amount Requested
Contribution to Course fees / £
Other costs: (please provide details of any additional funding applied for to support access to the coaching course, including costs associated with having a disability) / £
Total amount requested / £
Have you received any other grants or funding to support your coaching in the last 12 months? (please give details below)
Organisation/ grant giving body / Yes/ No
Amount received
4. Sports Club details
Do you currently coach at a sports club or other organisation?
Yes No
Please provide details of at least one sports club or organisation where you intend to coach after completing the coaching course named above. Please tick below which applies to the club details.
Currently coach at this club Currently volunteer at this club Not currently coaching at the club but Intend to coach at this club once qualified
Name of club/ organisation / Contact details for a representative from the club
Address of club/ organisation
Postcode / Email
Telephone
5. Supporting statement
Why do you want to do this coaching qualification?
How will you use your skills from the coaching qualification to benefit the community? Where, when and who will you be coaching?
What age group will you be coaching? (please tick all that apply)
Children under 11
Age 12 – 16
Age 17 – 18
Adults aged 18 +
6. Signatures

Declaration ( to be signed by the individual applicant)

  • I have completed this application to the best of my knowledge and understand that payment of a coach bursary is subject to the success of this application.
  • I agree to pay the full cost of the course upfront and provide evidence that I have booked the course before payment will be made by the AVSPAN

Please sign below to demonstrate you have read and understand your responsibilities as the coach.

Sign:………………………………Print: ……………………….. Date:......

Applicant

Reference

To be signed by a representative from the relevant National Governing Body or equivalent recognised body for the sport in question.

Name of National Governing Body (or equivalent) / Address of NGB
Address
Name of contact
First name Last name
Position or role
Telephone / Postcode
Email address
  • I can confirm that the course details submitted in this form are correct and that my organisation (state name of NGB)……………………………………. supports the applicant’s request for a coaching course bursary.

Sign: ………………………………Print: ……………………….. Date: ………………

NGB Representative

Email:

Post: AVSPAN Sport Bursaries, C/O Leisure Services, AVDC Council Offices, The Gateway, Gatehouse Road, Aylesbury, Bucks, HP19 8FF

Equalities Monitoring

Equalities Monitoring

In accordance with our equalities policy please complete this information. The information will not be used to inform any funding decisions but will help us to ensure that we are promoting the scheme as widely as possible.

What is your ethnic group?Please tick to indicate your ethnic group.

A : White

British☐

Irish☐

Any other White background (please write in)☐

B : Mixed

White and Black Caribbean☐

White and Black African☐

White and Asian☐

Any other mixed background (please write in)☐

C : Asian or Asian British

Indian☐

Pakistani☐

Bangladeshi☐

Any other Asian background (please write in)☐

D : Black or Black British

Caribbean☐

African☐

Any other Black background (please write in)☐

E : Chinese or other ethnic group

Chinese☐

Any other (please write in)☐

Not stated

  • Not stated☐

Application Check List

  • Have you told us about how your club/organisation and local community will benefit from you gaining this qualification (e.g. having more coaches to allow the club to grow and offer more sport to the community)?

Have you made sure that the total amount you have requested from us is no more than 75% of the costs of the course and no more than the maximum amounts shown below?
Level 1 course – up to £200 Level 2 course – up to £300 Level 3 course – up to £500
Have you spoken to a representative from the National Governing Body or equivalent for your sport and got them to sign below?
Are you going to be coaching outside of school curriculum time?
Are you going to be coaching within the Aylesbury Vale area?
Have you provided the full details of the course you will be attending?