GlosGirlsCan: Female Coaching Bursary

Application Form

Applications open 9am Wednesday 10th January & closes at 9am Monday 12th February 2018

Section 1: About You

First Name / Surname
Do you have a disability? / YES / NO / If yes, please detail: / Date of Birth
Email Address / T-shirt size
(Unisex: XS, S, M, L, XL, XXL)
Home Tel. No / Mobile Tel. No
Home Address
Twitter account / Instagram account
Ethnic Background
A: White / British / B: Mixed / White and Black Caribbean
Irish / White and Black African
Any other White background / White and Asian
Any other mixed background
C: Asian or Asian British / Indian / D: Black or Black British / Caribbean
Pakistani / African
Bangladeshi / Any other Black background
Any other Asian background
E: Chinese or other ethnic group / Chinese / F: Not Stated / Not Stated – please write below
Any other

Section 2: Your Coaching/Leading

  1. What sport or activity do you coach/leador would like to coach/lead following this course, training or personal development?

  1. Do you currently hold any coaching, leading or activating qualifications? If so, please detail these.

  1. How long have you been coaching/leading for?

Never / 1 month – 1 year / 1 – 5 years / 5 Years +
  1. If applicable, who and where do you currently deliver? Please detail as much as possible; location, age, gender, disability, standard, ethnic backgrounds, club/group name.

Section 3: The Qualification/Course/Training/ Personal Development

  1. What qualification/course/training/personal development are you looking to complete?

  1. What are the dates and location?

  1. What is the total cost?

  1. Are there any prerequisites to complete this course? If so, what are they? (e.g. Level 1 Qualification, DBS, First Aid)

Section 4: Your future as a coach/leader

  1. Why do you enjoy coaching/leading & what made you want to become a coach, leader, or activator? (max. 200 words)

  1. What impact will this bursary have on you as acoach/leader and those you work with?(max. 200 words)

  1. How will this impact upon Active Gloucestershire’s mission to get everyone in Gloucestershire active every day ? (max. 200 words)

  1. This section is for you to detail any additional information about you or the work you do that you feel would be useful or beneficial for us to know (max 200 words)

Section 5: References

Please give the name and address of two referees.
No reference will be sought without your consent.
Referee 1 / Referee 2
Name, address, phone number, email / Name, address, phone number, email
In what capacity does this person know you? / In what capacity does this person know you?

Section 6: Declaration

Please tick the boxes below to confirm the following should your application be successful.

You are female
You are aged 14+(or the minimum age to complete your chosen qualification)
You can pay for the course up front / have agreed for a third party to pay (ie. Club)
You are a Gloucestershire resident or will be delivering activity within Gloucestershire
You will attend complete the qualification within 1 year of submitting the application
You will provide evidence of your qualification & log book on completion

Signature:……………………………………………

Name:………………………………………………..

Date: …………………………………………………

FOR OFFICE USE, ONLY