APPLICATION FORM INDIVIDUAL ATHLETE PROGRAM 2016 SASI HIGH PERFORMANCE SCHOLARSHIP SASI PARALYMPIC SCHOLARSHIP Please read the 2016 SASI Individual Athlete Program Funding Guidelines before commencing this application form to check your eligibility status. If you have any questions the guidelines or application please contact SASI prior to submitting an application. Phone: (08) 8457 1432 or E-mail: Advice Notes Name and details of athlete for this application: eg: Mr All application correspondence First Name: will be directed to the athlete via the postal/email address Surname: provided. Date of Birth: Please use an email address that Gender: will be checked at least weekly as this will be the main source of Home Phone: correspondence. Mobile: Email: What is your residential address? The physical address where you Address: permanently reside. Suburb/Town: Postcode: What is your postal address? If different from your residential address. Address: Leave blank if this address is the Suburb/Town: same as your residential address. Postcode: You can only select one What scholarship are you applying for? SASI High Performance scholarship. SASI Paralympic Weightlifting, Shooting, Athletics, What sport are you applying for? Badminton etc. For example, an event / discipline What event(s) / discipline? of Swimming is 100m Freestyle. Are you registered with your State Your State Sporting Organisation YES NO is the peak body for your sport Sporting Organisation? within South Australia (eg Athletics SA). If Yes, what is your licence number? To be eligible for funding you YES NO Are you an Australian Citizen? must be an Australian Citizen. Applicants residing more than Is your residential address more than 130km from 130km from the Adelaide GPO YES NO the Adelaide GPO? are considered County athletes. Are you of Aboriginal or Torres Strait Islander YES NO origin?
APPLICATION FORM INDIVIDUAL ATHLETE PROGRAM 2016 SASI HIGH PERFORMANCE SCHOLARSHIP SASI PARALYMPIC SCHOLARSHIP Please read the 2016 SASI Individual Athlete Program Funding Guidelines before commencing this application form to check your eligibility status. If you have any questions the guidelines or application please contact SASI prior to submitting an application. Phone: (08) 8457 1432 or E-mail: Advice Notes All application correspondence will be directed to the athlete via the postal/email address provided. Please use an email address that will be checked at least weekly as this will be the main source of correspondence. Name and details of athlete for this application: eg: Mr First Name: Surname: Date of Birth: Gender: Home Phone: Mobile: Email: The physical address where you permanently reside. What is your residential address? Address: Suburb/Town: Postcode: If different from your residential address. Leave blank if this address is the same as your residential address. What is your postal address? Address: Suburb/Town: Postcode: You can only select one scholarship. What scholarship are you applying for? SASI High Performance SASI Paralympic Weightlifting, Shooting, Athletics, Badminton etc. What sport are you applying for? For example, an event / discipline of Swimming is 100m Freestyle. What event(s) / discipline? Your State Sporting Organisation is the peak body for your sport within South Australia (eg Athletics SA). Are you registered with your State Sporting Organisation? YES NO If Yes, what is your licence number? To be eligible for funding you must be an Australian Citizen. Are you an Australian Citizen? YES NO Applicants residing more than 130km from the Adelaide GPO are considered County athletes. Is your residential address more than 130km from the Adelaide GPO? YES NO Are you of Aboriginal or Torres Strait Islander origin? YES NO
SASI_Application_Form_HP_and_Paralympic_2016.docx