HIGH PERFORMANCE PROGRAM

DEVELOPMENT SQUAD APPLICATION

Applications are due Monday9July 2012

Applications will be kept strictly confidential and sent to or placed in a sealed envelope, marked Attention: Tommy Michael. They can be lodged by mail To Diving Victoria, Box 9, MSAC Aughtie Drive Albert Park 3206

To complete the form please click on the grey box and fill in the details

PERSONAL DETAILS

Surname: / Given Name / Date of Birth:
Club: / Current Coach:
Address:
Suburb: / Post Code: / Phone:
E-mail: / Mobile:

Please insert a headshotphoto in the first box and two other diving shots of you in Boxes 2 & 3:

Box 1Box 2Box3

Insert Headshot Photo / Insert Diving Photo / Insert Diving Photo

GOALS:

Briefly explain why you are applying for the Development Squad 150 words max:

What would you like to achieve in the next 12 months?

What would you like to have achieved in 5 years time?

In what areas do you think the High Performance Program can assist you to achieve your goals?

PAST RESULTS:

  1. Details of any international or national team representation and/or selection in past 2 years
  1. Details of your achievements where appropriate at a National and State level over the past 12 months.

State Championships & Qualifying Events 2011 /12
Event / 1M / 3M / Platform
Score / Place / Score / Place / Score / Place
2011/12 National Titles
Event / 1M / 3M / Platform
Score / Place / Score / Place / Score / Place
Age April 2011
Elite Junior July 2011
Open December 2011
Age April 2012
Elite Junior July 2012
  1. Please provide details of current optional dive list and DD on each board or platform

(Please note: maximum of 5 dives from different groups for 1M and 3M and maximum of 6 dives from different groups from platform)

Platform
1M / DD / 3M / DD / 5 Metre / DD / 7.5 Metre / DD / 10 Metre / DD

Declaration Diver

I am aware of the objectives and philosophy of the High Performance Program and acknowledge the commitment that will be involved. If this application is successful I will work within guidelines and rules of the program and sign the divers’ code of behaviour and contract with Diving Victoria.

Signature ______Name: Date

Declaration Parent/Guardian

I am aware of the objectives and philosophy of the High Performance Program and acknowledge the commitment that will be involved. If this application is successful I will work within guidelines and rules of the program and sign the parents’ code of behaviour and contract with Diving Victoria on behalf of my child.

Signature ______Name:Date