Nottingham Trent University Student Talented Athlete Recognition Scheme (STARS) Application Form

Nottingham Trent University 2016-17 Sport Scholarship Application Form Please complete electronically where possible Personal Details Titl Surname First name e Date of Birth

Height Weight

Term-Time Address

Home Address

Tel Mobile

E-mail

Twitter

Course Details

Course studying /applied for

Department or School Total Course Length Year of Study (1st/2nd/3rd/4th) (Years) Academic Tutor Student / UCAS ID (if known)

Sport Details

Sport Discipline / Position

Current Performance Level/Ranking: Please Specify: - International level (Junior/Senior) - National level (UK, County, World) - League? - Team (1st, 2nd Junior, Senior)

An example: GB Rank 2nd in Junior Team and Premier Division within Nottingham

of 3 Edited by AB on 27.03.12 Current Club (s) (Please specify if you will be competing in these clubs during your time at NTU)

Previous Sporting Achievements (Please specify international and national competitions)

Sporting Aims & Ambitions (Please specify Short-term and Long-term goals)

Why should you be awarded a Sport Scholarship?

Additional Information (What Sport Science support have you previously received, Injury information) Nottingham Trent University 2016-17 Sport Scholarship Application Form

Media Evidence

Please accompany your application form with the following:

 Video footage of 3-4 Clips from separate competition fixtures – Please specify the competition  Photo – Of yourself in sporting action representing your highest representative club

N.B. Only the following sports are required to submit Video Footage:

- Basketball - Cricket - Football - Futsal - Hockey - Volleyball Reference Details (Coach or NGB Contact)

Position Club or NGB

Address

Email Tel

PLEASE NOTE:

Applications will not be considered without a reference and either a student ID or UCAS number and a supporting statement.

Successful selection is subject to agreement of the terms and conditions in the Athlete Contract and each applicant reserves the right to withdraw from the process at any time.

Declaration (Applicant)

I certify that the information in this application is correct to the best of my knowledge:

Signed Date

of 3 Edited by AB on 27.03.12