SKEGGS FOUNDATION Inc.

ATHLETE APPLICATION FORM

(September 2016)

Incorporating the Regional Offices of:

SKEGGS FOUNDATION INC.

APPLICATION FORM

KEY OBJECTIVE

The Skeggs Foundation exists to support the elite and aspiring athletes of Otago to represent their province and country while remaining in Otago.

BACKGROUND

The Foundation was launched in September 1993 to ensure Otago's sports people would have an equal opportunity to compete to the highest levels while remaining available to Otago provincial selectors. Preference is given to athletes who remain residents of Otago. The Foundation wants Otago’s stars of the present and the future to be given the chance to display their skills, and not be disadvantaged by geographical location, travel costs, or the lack of top competition or the lack of exposure to national selectors. The intention of the Trustees is to provide a hand-up to our athletes so they can reach the higher levels of their sport.

GRANTS

Grants will be determined by the following guidelines:

·  Athletes should be resident in provincial Otago, including: Dunedin City, Waitaki District, Clutha District, Central Otago District and Queenstown Lakes District. Certain exceptions may be made by the Trustees where they consider there are extenuating circumstances. Those residing outside Otago for reasons not related to their sport will be ineligible.

·  Athletes must be available for selection for Otago provincial teams or squads. Where there is no provincial competition for a sport they should have an Otago club or applicable Southern area/regional affiliation.

The Trustees of the Foundation decide all grant applications and their decision is final. No correspondence will be entered into.

CONDITIONS OF GRANT:

o  Applicants must reside in Otago. Some exceptions can be made but successful applicants must be available for selection in Otago teams.

o  A report from the athlete about their performance and how the money has benefited them, must be returned to Sport Otago not later than four months after receipt of the grant. For the March round, reports will be due by 20 August, for the September round reports will be due by 20 February. Failure to write reports will result in ineligibility for future funding.

o  If a grant is not uplifted by 20 August (for the March round) or 20 February (for the September round) it will expire and the applicant will no longer be eligible to receive it.

o  The Foundation can use an athlete’s name and/or image to further promote the Foundation and its aims.

o  Athletes must abide by the World Anti-Doping Agency guidelines on the misuse of drugs. Athletes are required to return the grant monies, should they test positive to any banned substance.

o  To be available if required, to Skeggs Foundation corporate members for promotional duties. Such duties to be arranged by mutual consent.

Return to: Skeggs Foundation, Sport Otago, PO Box 969, Dunedin 9054

Name:
Date of Birth:
Sport:
Postal Address:
(Please include Postcode)
Email Address:
Telephone Number:
Preferred Contact Method: / Email / Postal Address
Have you received a Skeggs Foundation Grant before? / Yes / No
Do you (or your parents) have a Skeggs Foundation Mobil or BP card?
COMPLETE ALL SECTIONS OF THIS FORM / Yes / No
List your greatest sporting achievements of the past year or season, starting with the most recent.
List your goals for the next 12 months. Specify competitions, events or team selections you are targeting.
List your ambitions for the next 3 – 5 years. Where do you want to go in your sport?
If you have received a Skeggs Foundation grant before, what PROGRESS have you made in your sport since you received it?
If you have received a Skeggs Foundation grant before, how did you promote it and tell people the Foundation supported you?
What you will use the grant for?
What support have you received in the past 12 months from all sources related to your sport? i.e. HPSNZ, PEGS, prize money, personal sponsorships. Please state type and source. If you choose not to declare a value for legal or privacy reasons one will be estimated based on similar known income sources.

Proposed budget for the next 12 months. Your best estimate is acceptable if it is based on information known at the time you are making this application.

Your Projected Expenses / Your Projected Income
Type of expense / $ / Type of Income / $
Accommodation / PEGS
Travel / Prize money
Coaching / Sponsorships
Training Camp / Appearance fees
Equipment / Other personal grants
Other (specify) / Other (specify)
TOTAL / TOTAL

Certification by Provincial/National Body

The Executive Director, Chief Executive Officer, High Performance Director or equivalent for your sport is to sign this application to certify that the information supplied is correct and acknowledges that the applicant has the potential to reach high standards, and that the financial information provided could reasonably be considered a fair estimate.

Name:
Position Held:
Organisation:
Contact Telephone Number:
Contact Email Address:
Date:
Signature:

Declaration

I declare that the information supplied within this application form is factual. If this application is successful, I agree to take part in promotional work as required by the Skeggs Foundation Inc. and/or its corporate supporters for the 12 month period from the payment of the grant. This promotional work will be fulfilled at no charge to the Skeggs Foundation Inc. or its corporate supporters.

I expect to remain available for Otago selections for the next 12 months. I accept that a refund of my grant will be required if I move and represent another province within this agreed period.

Applicant Signature:
Parent/Guardian Signature:
Date Signed:


NOTES TO HELP WITH COMPLETING OF APPLICATION:

·  The applications may be emailed to but the emailed documents must be followed by hard copies, properly signed, and sent to: Skeggs Foundation, Sport Otago, PO Box 969, Dunedin 9054.

·  A completed application is regarded as one that contains all the required information, including endorsement from a national or provincial sporting body and all requested financial information.

·  The provision of any misleading, incomplete or false information will result in ineligibility for future funding.

·  Attach additional pages if more space is required. If you have received a grant in the last year, please ensure you complete the section “my progress”.

·  Applicants should include addresses at which they can be contacted at all times (e.g. student flats and home residences). Similarly with contact telephone number, please list mobile numbers if available.

·  If your contact address is outside of Otago you will be required to provide evidence your normal residence is within the province, or why you believe there are extenuating circumstances the Trustees should consider.

·  When applicable, be as informative as you can be with sporting facts. Times, distances (e.g. 3.32.2 for 1500 metres, 8.50m for long jump) should be given because these can be more indicative of performance than a placing.

·  Applicants must complete the application forms; parents or coaches cannot carry this out on the athletes’ behalf. A parent or guardian is only required to sign the application for applicants under the age of 16.

·  Applications must be made on this form.

·  If applications are sent electronically, it must be followed by a hard copy by the due date.

·  Applications close each year on 20 March and 20 September at 5.00pm. Late applications will not be accepted.

Please ensure that the forms are legible if completing by hand. If the form is illegible this may lead to delays or mistakes in the processing of the application.