Coaching Grant Scheme Application Form

Coaching Grant Scheme Application Form

Please refer to the Coaching Grant Scheme (satellite clubs) Guidance Notes at www.cswsport.org.uk/coaching for detailed information before making an application.

SECTION 1 – Personal Details (of applicant attending the course)

Name
Address
Post Code
Contact Number (mobile) / Contact Number (home)
Email

SECTION 2 – Details of course. Course must be a relevant coaching or leadership qualification.

Course Title
Sport/
Full Course Cost / £
Amount applying for / £
Are you receiving any additional funding for this course? / Yes/No
If yes, how much £
Who is providing the funding?
Course Dates / From / To
Course Venue
Course Organiser

SECTION 3 – Club or organisation’s details

You will need to complete all of this section. The contact name for the club or organisation must be in a relevant position For example a Club Chairman.

Club/Organisation
Name of contact
Position within the club or organisation
Club/Organisation Address
Postcode
Contact Number
E-mail
Clubmark status (delete as appropriate) / Yes / No/ Working towards/ N/A

SECTION 4 – Satellite Club project

In this section please briefly outline the details of the Satellite Club you will apply for funding to deliver. For information on Satellite Club refer to http://www.cswsport.org.uk/clubs/satellite-clubs .

Satellite club name and location: / Has a satellite club application been approved by CSW Sport?
Date the club commenced or will commence: / Main satellite club contact?
Briefly outline how the training or qualification will assist in helping to the deliver satellite club sessions which are creating an UNMISSABLE experience for young people age 11-25. Please use the UNMISSABLE guidance to show which area your training will relate to, e.g. ‘creative’ **:

Declaration (to be signed by both the coach and the designated contact within the club / organisation)

Please sign below to demonstrate you have read and understand the Coaching Grant Scheme (Satellite clubs) Guidance Notes.

Name: ...... Position: ...... Date: ......

(Club or Organisation)

Name: ...... Position: ...... Date: ......

(Coach)

Please complete and return the application form to Ciara O’Brien email to: Ciara.o’ or by post to CSW Sport, Riverside House, Milverton Hil, Leamington Spa, CV32 5HZ.

If you require any assistance completing this form, please contact Ciara: Ciara.o’ or 07885 200 503

** More information on unmissable can be found here:

http://www.sportscoachuk.org/resource/youth-insight-animation-series
Equality Monitoring Form

Data Protection:

Data Protection Act 1998 – The data provided will enable Coventry Solihull & Warwickshire Sport to perform its obligations for recording, monitoring, reporting and improving service delivery and for demonstrating achievement of the standards as set out in “The Equality Standard – A Framework for Sport”. Coventry Solihull & Warwickshire Sport aims to provide equitable provision of services for all. The information below will be used to ensure that we achieve our aim.

Data Capture:

Date of Birth: / Gender:
What is your ethnic group? – Choose ONE from A to E, then tick the appropriate box to indicate your cultural background.
A White / B Mixed / C Asian or Asian British / D Black or Black British / E Chinese or other Ethnic Groups
British / White & Black Caribbean / Indian / Caribbean / Chinese
Irish / White & Black African / Pakistani / African
White & Asian / Bangladeshi
Any other white background please state below / Any other mixed background please state below / Any other Asian background please state below / Any other Black background please state below / Any other, please state below
Do you consider yourself to have a disability? YES NO (Please circle)
If yes, what is the nature of your disability? / o Visual
o Hearing
o Physical
o Learning / o Multiple
o Other
o Prefer not to say