Isle of Wight Council

SPORTS GRANT APPLICATION FORM FOR INDIVIDUAL SPORTSPERSONS

PERSONAL DETAILS

	Title
*	Forename
	Middle name/Initials
*	Surname

*	Building/house name/number
*	Street address
*	Town Name
*	Postcode
	Tel Number (include area code)
	Mobile Tel Number
	Email address
	Date of Birth

If application is being made on behalf of a junior applicant please complete the following

	Application on behalf of
	Name
	Address
	Date of Birth
	Sport (s)
	Name and Address of Club which applicant is a member
	Coach name
	Tel number

GRANT

	Please detail the purpose of the grant (e.g. travelling, coaching, specialist equipment)
	Detail your standards and achievements attained in your chosen sport(s) (e.g. County, Regional) please attach relevant press cuttings and written evidence

	Detail all financial assistance or sponsorship received, including help from other funding sources	�

	Give details of training undertaken on both the Island and Mainland
	Give any other information you wish to submit in support of your application (please add further sheets if necessary)

DECLARATION I hereby declare that the individual sportspersons grant conditions as set out on the attached sheet are fully understood and that the statements made on this application form may be relied upon in the determination of any grant award. I understand that information from this form may be computerised for administration purposes, in accordance with the Data Protection Act 1984.

Signed:........................................................... PRINT NAME:.................................................... Date:..............................................................

PLEASE COMPLETE THE ANALYSIS SHEET THAT FOLLOWS THIS PAGE. IF YOU ARE UNABLE TO SUBMIT THIS FORM ON-LINE PRINT YOUR COMPLETED FORM AND SEND TO : The Isle of Wight Council Sports Unit Cultural & Leisure Services Guildhall, High Street, Newport, IW PO30 1TY

	Analysis Sheet
	INDIVIDUAL YEARLY TRAVEL / TRAINING PROGRAMME April 1 current year to March 31 following year

	DATE	Details	TOTAL COST INCURRED �
		EVENT/ COMPETITION TRAINING / EQUIPMENT DETAILS VENUE RESULTS
		EVENT/ COMPETITION TRAINING / EQUIPMENT DETAILS VENUE RESULTS
		EVENT/ COMPETITION TRAINING / EQUIPMENT DETAILS VENUE RESULTS
		EVENT/ COMPETITION TRAINING / EQUIPMENT DETAILS VENUE RESULTS
		TOTAL �

	Data Protection Act 1998
	This application may be monitored by the Isle of Wight Council for regulatory, quality control or crime detection purposes. Information from this application will be processed in accordance with the Data Protection Act 1998 for the purpose of processing your particular enquiry/request. The Isle of Wight Council ("the Council") is the data controller. By completing this form you consent to the Council contacting you by email or nominated contact method in relation to your enquiry/request. The information contained in this application may, in exceptional circumstances, be subject to disclosure to third parties under either the Data Protection Act 1998 or the Freedom of Information Act 2000 to the extent the law allows and in accordance with the Isle of Wight Council's Access to Information Policy. Disclosure will only be made where in all the circumstances it would be fair to do so and in the public interest. Please note that the Council may process your information in the absence of consent for the purpose of crime prevention or detection so far as is in accordance with the law. Sometimes we may use your information to keep you informed about services, goods or relevant issues that we believe may be of interest to you. If you wish to receive this information for these purposes please tick this box To improve the quality of other services that we provide to you the Council wishes to hold your non-sensitive personal information on a secure central database. This will enable all Council services to use this information when they are providing a service to/for you. If you wish your non-sensitive personal information to be held by the Council please tick this box

Date printed: 07/03/2013