The Derbyshire Talented Athlete Fund Application Form for Performers in Non Priority Sports

Please complete each section of this form clearly and as fully as you can. The Grant Panel will only use this information to assess your application for an award of grant.

When you have completed the form please click onto the SUBMIT button located at the bottom of the page - you will receive a message stating that it has been successfully submitted.

If you would prefer to download a copy of the form and complete it by hand, then please click here. The form can then be faxed to 01773 571239 or sent via post to: FAO Daniel Newton, Derbyshire Sport, 2 Godkin House, Park Road, Ripley, Derbyshire, DE5 3EF.

SECTION 1 - DETAILS OF APPLICANT
     
     
  Address of applicant, including post code    
     
  Gender  
 
SECTION 2 - DETAILS OF PERSON NOMINATING IF UNDER 18 YEARS OF AGE
     
     
  Address    
     
     
     
SECTION 3 - DETAILS OF REGIONAL/NATIONAL GOVERNING BODY
Please provide the details of the regional/National Governing Body contact person who can verify information within this form.
     
     
  Address    
     
     
SECTION 4 - COMPETITION AGE REQUIREMENTS
Please confirm the age groups that performers can compete for England or GB within your sport/discipline.
SECTION 5 - DETAILS OF APPLICATION
Please provide the reasons for you application. You need to include details of national and international achievements, national ranking and regional/national/international representative honours. You should also include an assessment of potential to compete successfully at junior and senior international levels for England or GB.
Details of national and international achievements and representative honours
Details of current national rankings (where appropriate)
Assessment of potential to compete successfully for England or Great Britain
SECTION 6 - DECLARATION

We declare that, to our knowledge, the information given on this application form is true and correct at the time of submitting this application form. We confirm that, if Derbyshire Sport agrees to give a grant, we will comply with any conditions attached to any financial help.

Data protection - all personal information provided by you is necessary to process your application for a grant. We will treat the information in confidence and in accordance with the Data Protection Act 1998. We may need to check some of the information with other bodies such as Regional/National Governing Bodies. By signing this application, you agree that we may do this.

The person submitting the application for performers under 18 years of age
     
    (day-month-year) 

The performer
     
    (day-month-year)