SUSSEXSPORT

Sports Scholarship Scheme

Application Form 2017/18

Name
Date of Birth
Nationality
Sport
Event
Club
Current Level (i.e. International national, regional or county)
Home Address / Term Time Address
Email
Telephone (mobile/other)
Emergency Contact and
Relationship
Course Title and School
Year of Study (during 2016/17)
UCAS Number/Student Number
Do you receive any other financial support? (NGB/Grants/Pro-Semi Clubs)
How did you hear about the scheme?
Are you committed to representing the University both in competitions/events and as an ambassador?

YesNo

Which scheme are you applying for?

High Performance SchemePerformance Athlete SchemeDevelopment Athlete Scheme

How do you feel the scheme can help you become a better athlete? What particular areas of the scheme do you feel you would benefit from most?
Sporting Achievements
Please give us details of your most current achievements including representative honours, competition performances and personal bests. Please give as much information as possible e.g. dates, level and number of competitions
Sporting Goals/Aspirations
Please give details on your sporting goals in the next 12 months and any longer term goals. Please give dates, levels of competition and other relevant information

References

Personal (team mate/colleague)
This can be from someone from within your sport or club e.g. teacher, coach, club official etc. stating your suitability for the scheme
Please arrange for a letter to be sent to Terry Cooper (address at the bottom of the form) or they can send this by email to:
Name
Address
Email
Sport (coach/performance director)
This testimonial should confirm your performances. Ideally it should be from someone who has an overview of the performances at your level e.g. your National Governing Body or National Team coach. Your club coach is not ideal as they are not necessarily that objective. Please add the name and address of the person writing your sporting testimonial below.
Please arrange for a letter to be sent to Terry Cooper (address at the bottom of the form) or they can send this by email to:
Name
Position/Title
Address
Email

Supporting Statement

On a separate sheet and typed, please express in your own words why you wish to be considered for a scholarship at the University of Sussex and how you would benefit from it (include reference to specialist services and financial support and how this would influence your long term goals - maximum 300 words)

Signature of applicant: ______

Date: ______

Please return your completed application form to:

Terry Cooper, Deputy Head Operations, Fitness and Performance, Sport Centre, University of Sussex, Falmer, Brighton BN1 9RB oremail your form to:

Please note, applications close Friday 29September 2017