Details of the person you wish to be awarded the bursary:


Sports Bursary
Application form / For Office use
Club
WSF member?
Your nomination must be received by email or post on or before Friday 15 July 2016
Full Name.
/ Male/female / Date of Birth / Age
Address:
Postcode.
Tel No: / Email:
SPORTING DETAILS
SPORT
Name of Club:
Is the club a member of the Wirral Sports Forum? Yes No
Current Ranking in sport:- Please identify in the following headings.
Event / Ranking
INFORMATION ABOUT THE GRANT YOU ARE REQUESTING
(A maximum of £200 applies)
Total amount requested / Total amount of your expected costs
Have you applied for other funding?Yes  No 
If YES, where and how much?
WHY are you applying for this grant?
WHAT you will use the grant for?
If necessary, use separate sheet to complete this section.
Name and address of the person the cheque is to be made payable to:
(This should be the recipient or their representative, e.g parent or carer, not their club or coach;).
Name:
Address:
Postcode:
1 I understand that this application must comply with the criteria laid down by the Wirral Sports Forum and that the decision of the selection panel is final.
2.I understand that I may be asked to assist in the promotion of the Sports Bursary Scheme in the media following the award.
3.I understand that I may be required to submit an end of award report, using the template supplied to me.
Application completed by: ______
Contact Number______
Contact Email ______
Connection to nominee (eg coach, team mate, parent etc)______
To the best of my knowledge the information provided is correct  Date ______
Signed by the person making the nomination:______
This form should also be signed by Club Official/Coach
Sign: Date:
Officer position:
Coach:
Now please email this form to the Wirral Sports Forum Secretary attaching a photograph (JPEG) of the nominee ‘in action’
Disclaimer: These photographs may be used at the Awards Ceremony and if the nominee is success they will be used at the Wirral Awards Event and will be passed on to the Merseyside Awards organisers. They may also be used for regional media publicity
email:
Postal entries will also be accepted
Dave Simmonds
Community Sports Development Officer
West Kirby Concourse Leisure Centre
Grange Rd,
West Kirby,
Wirral
CH48 4HX
Tel: 0151 666 4165
Mob: 0787 657 7187

NB The proceeds of the Merseyside Future Sporting Champions Dinner organised by Merseyside Sports Partnership contribute towards the Wirral Bursary fund.

Guidance notes for application.

Please read these guidance notes before applying for funding.

  1. Purpose of grant: To assist the development of individual sports persons in Wirral.

Grants will be awarded according to the criteria and personal needs.

  • There is no age limit to applications
  • Individuals applying must either reside in Wirral or represent a Wirral Club
  • Priority will be given to members of a club that in turn is a member of the Wirral Sports Forum.
  • Applications will be received from all sports.
  • Applications may be received for the following:

Kit, equipment, travel expenses, costs of lodging when competing away from home, other competition costs, personal development for those wishing to extend their sporting career, specialist coaching, other coaching programmes.

  • Successful applicants will be required to complete an end of grant award report, saying how the grant was used, with if possible receipts for equipment purchased.
  • Grant monies must be expended solely on the items being claimed. The Sports Forum reserves the right to reclaim any grant not being used for the specific activity within the grant application.
  • To enable accurate recording of grants provided by the Sports Forum, a database will be in operation and shared with the overarching body of Merseyside Sport. This database will be used for Monitoring and Evaluation purposes of applications and grants awarded.
  • Repeated applications for the same purpose will not be accepted.
  • The successful applicant is to be available for media coverage.
  • The decisions of the Wirral Sports Forum panel will be final.