Isle of Wight Council

COACHING & OFFICIATING BURSARY APPLICATION FORM

PERSONAL DETAILS

Title

other title (please specify)

	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
	Name and Address of Club of which applicant is a member

CURRENT COACHING DETAILS

	Sport
	National Governing Body

Coaching Qualifications Currently Held

	Qualification	Date Achieved

	Give the names of athletes and/or teams/clubs which you are currently coaching
	No. of Years
	Current Coaching Commitment	hours per week

PURPOSE OF BURSARY

Please give details of the education / training programme / coaching course / officiating course which you wish to follow:

	Title of Course
	Venue
	Cost of Course �
	Travel Costs �
	Other Costs � (please specify)
	TOTAL �

	Amount contributed by applicant �
	Amount contributed by club �
	Grants from other funding bodies � (please specify)
	AMOUNT OF BURSARY APPLIED FOR �

SUPPORTING STATEMENT

	Please indicate, in the space provided, the benefit of this training to you and to your athlete(s) / team(s) / club (s)

DECLARATION To the best of my knowledge, the details in this application are correct. Signed:................................................. PRINT NAME............................................. Date:...................................................... RETURN COMPLETED FORM TO: The Isle of Wight Council Sports Development Unit Guildhall, High Street, Newport, IW PO30 1TY e-mail [email protected]

	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