VOLUNTARY CYCLING COACH

APPLICATION FORM

Personal Details

Surname: / Forenames: / Title:
Address:
Postcode: / Email:
Main contact telephone number:
Date of Birth:
Are you a Sport Maker? Yes / No
Are you a student? Yes / No
If yes where and what are you studying: / Alternative number:
Are you a British Cycling Member? Yes / No
If yes give number:

Club Details

Which cycling club will you be coaching with (if known):
Which British Cycling Coaching Course are you seeking funding for (please tick one):
Level 1 Award in Coaching Cycling / Level 2 Certificate in Coaching Cycling
Level 2 Discipline-specific Awards:

Level 2 Road and Time-Trial

/

Level 2 Track

/

Level 2 BMX

Level 2 Cycle Speedway

/

Level 2 Cyclo-Cross

Please note this funding will not fund level 3 coaching courses
Have you identified course dates that you wish to attend (if so give dates):

Course Details

Relevant Training/Awards

Date of Training (DD/MM/YY) / Title (E.g. scUK Safeguarding & Protecting Children / First Aid/ other coaching awards)
RELEVANT INFORMATION
Please use this space to describe what skills / abilities you possess that would make you suited to this area of work, and in relation to the role description (Please limit to a maximum of one side of A4).
Please read the following statement and sign the declaration below:
As the individual named above, I agree to hold in confidence any information regarding West Yorkshire Sport and the British Cycling which, I may obtain during the course of this post.
I also understand that as I may have access to confidential information, I agree to abide by the rules and regulations pertaining to Data Protection Act 1998 and that I must not discuss or disclose any information, without the explicit written consent of the individual and British Cycling
Print name: Sign name: / Date:

Thank you for completing the application form, please return via email to:

Les Ford, WYSport –

Application deadline: Sunday 6thSeptember 2015