ACPE - Elite Athlete ID Form

Elite Athlete Identification Form

Name: SID: ______Intake: __ __ / Mobile: ______Study Load: # of Units 1. Indicate Sport or Performing Art: Details:

2. Team/club name and level: Details:

3. Are you a member of a Player Association or First Grade squad/team? Yes / No (Circle)

Details :

4. Highest Level of representation/performance in 2016 (State, National): Details:

5. Are you a member of an Academy or Institute Program including Emerging Athlete Program with NSWIS? Details :

6. Are you a member of a Junior or Senior State Representative squad? Details :

7. Do you compete for a club in a National Sporting competition (see below)? Details :

8. National Sporting Competition are categorised as (please tick relevant):

Senior competitions:

 Australian Football League (AFL) - AFL

 National Rugby League (NRL) – NRL (includes feeder teams NSW Cup)

 Football Federation Aust (FFA) – A-League & W-League

 Australian Water polo – Men’s & Women’s NWPL

 Sheffield Shield - Cricket

 National Basketball League - WNBL/NBL/WABL

 Australian Hockey League - AHL

 Super 14 Rugby Union Youth competitions (U20):  NRL - National Youth Competition (includes feeder teams NSW Cup)  FFA - National Youth League ACPE Limited trading as The Australian College of Physical Education ACPE - Elite Athlete ID Form – F-182 Version: {_UIVersionString} Page 1  Basketball – Youth League

9. Other Sporting pursuit or activity not covered above such as dance?

Please provide details of performance art or sporting participation level and club/team information: Details:

10. What do you consider to be your greatest achievement so far?

Details:

11. What is a typical week like for you in regards to training load? (Enter hours in boxes)

Monday Tuesday Wednesday Thursday Friday Saturday Sunday

12. At what time of the year do you feel the most under pressure from your sport or performing art? Details :

13. At what time of the year, if any, are you likely to require extended leave from ACPE? Details :

14. Is it possible that you will be required to travel overseas in semester 1 or semester 2 of 2017? If so can you indicate the month/s? Details :

Biography (to be included on APCE website) …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………………………………………………………………………………………………………… …………………………… *Please attach an action image of yourself with that you have copyright to ACPE

Declaration I declare that all the information submitted is true and complete. I give permission for ACPE to use my name and image for marketing and promotional purposes relating to my enrolment in the Elite Athlete Program. I authorise ACPE to verify my level of representation by making contact with my sporting organisation, and that this will be reviewed annually. I understand my status as an elite athlete or official may be revoked if any information provided in relation to my application is found to be ACPE Limited trading as The Australian College of Physical Education ACPE - Elite Athlete ID Form – F-182 Version: {_UIVersionString} Page 2 incomplete, misleading or inaccurate. I understand and am comfortable with my image and story being shared on ACPE’s website, and owned social media accounts such as Facebook.

Signature:______Date:__/__/__

All applicants must submit documentation from their club in addition to this form stating their level of representation. All applicants will be reviewed by the Elite Athlete Coordinator prior to selection.

Please send your application to [email protected]

ACPE Limited trading as The Australian College of Physical Education ACPE - Elite Athlete ID Form – F-182 Version: {_UIVersionString} Page 3