2205 VICTORIA AVE.

REGINA, SKS4P 0S4

(306) 780-9291 or 780-9238

Mike Mintenko Swimming Scholarship2015 Application Form

The Mike MintenkoScholarship has been made possible from the proceeds of the sale of the Mike Mintenko2004 Journey to Athens Calendar and from the fundraising clinics and dinner run last October 2013.

The intent of this swimming scholarship is to: Assist youth age swimmers to pursue excellence.

One Swimmer will be selected from applications received. The recipient will receive $1,000 which will be made payable to the swimmer’s club. The money is to be used for the individual’s training, competition or travel costs. The money is not to be assigned to the swim club general operating account.

To qualify to apply for this scholarship, swimmers must meet the following criteria:

A Winter Competitive swimmer currently registered with Swim Saskatchewan Inc.

If submitting this application then you also required to have registered with your swim club, paid the fees to the club you are joining and have completed your online registration in the Swimming Canada national registration database all by: Thursday, October 15, 2015

A member of good standing with: both the club that the swimmer is a member of AND with Swim Saskatchewan Inc. (i.e. no outstanding fees owing to SwimSask for past trips & no outstanding fees to your club for last season)

Female age 13 to 16 (age as at August 31, 2015).

Male age 14 to 17 (age as at August 31, 2015).

Must have achieved Short Course or Long Course times equal to or better than the Western Canadian Open standards.

The swimmer’s coach must endorse this application.

All of the information provided will be kept confidential.

Personal Information:

Please print legibly.

Name: ______

Address: ______Phone: ______

City: ______Postal Code: ______

Email: ______Fax: ______

Date of birth: ____/____/______

dd mm yyyy

The information that is provided in this application is a true and correct representation. Application is to be completed by the athlete, NOT the parent. Swimmer may ask parents for help with the financial information, but parents are not to do the work.

______

Signature of athlete Date

Financial Information:

Complete the summary below and ensure that it is included as part of your application.

Financial Information Summary – What does it cost you to swim?
Actual expenses
for last season
Sept 2014 to August 2015) / Estimated expenses for the current seasonSept 2015 to August 2016
Direct expenses related to competition & training:
Club Fees
Competition related expenses (i.e. meet fees, transportation)
Equipment costs
Sport Medicine/Science expenses
Other: (list)
TOTAL direct expenses

Please attach detailed responses to the questions listed below:

This information must be provided in typewritten format and organized as formatted below.

Athletic Performance:

NOTE: You need to provide detailed information. Committee members only select the recipient based on information provided in this application. Your chance of being selected with very little information provided is pretty slim.

  1. List all the qualifying times that you currently have for Western Championships.
  2. Highlight achievements/success you had during the last swimming season; 2014-2015(i.e. finalist at last year’s Western Canadian Open, or finalist at Senior Nationals).
  3. Outline your upcoming competition schedule for the current 2015-2016 season.
  4. List your goal(s) for this current season.
  5. Explain why you are aspiring to achieve this goal(s).
  6. List your long-term goals.
  7. Outline your training program, both swimming and dry-land or cross training.
  8. If you were to be the winner of this scholarship, explain how the money would help you achieve your goals and/or assist you in attending additional competitions.

Additional Information:

Feel free to list or provide any further information that you feel will enhance your application.

______

Information from Coach: (Coaches, you must provide as much detailed info on this swimmer. You need to back-up what the swimmer is stating in the application as his/her goals and if they are committed and have good attendance etc.)

______

Feel free to attach or provide any further information on this swimmer, that you feel will enhance his/her application

Coach Endorsement:

By signing below, I am endorsing this application for this athlete..

______

Name of Coach (please print)Signature of CoachDate

If submitting this application then you also required to have done your online registration in the national registration database and have submitted your fees to the club you are joining by: Thursday, October 15, 2015.

Applications must be received no later than Tuesday, October 27, 2015

Return Applications To:Swim Saskatchewan Inc.

Mike MintenkoSwimmer Scholarship Phone: (306) 780-9238

2205 Victoria Ave.Fax: (306) 525-4009

Regina, SKS4P 0S4Email:

Swimming excellence for all