<p>Nottingham Trent University 2016-17 Sport Scholarship Application Form Please complete electronically where possible Personal Details Titl Surname First name e Date of Birth</p><p>Height Weight</p><p>Term-Time Address </p><p>Home Address</p><p>Tel Mobile</p><p>E-mail</p><p>Twitter</p><p>Course Details</p><p>Course studying /applied for</p><p>Department or School Total Course Length Year of Study (1st/2nd/3rd/4th) (Years) Academic Tutor Student / UCAS ID (if known)</p><p>Sport Details</p><p>Sport Discipline / Position</p><p>Current Performance Level/Ranking: Please Specify: - International level (Junior/Senior) - National level (UK, County, World) - League? - Team (1st, 2nd Junior, Senior)</p><p>An example: GB Rank 2nd in Junior Team and Premier Division within Nottingham</p><p>Page 1 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)</p><p>Previous Sporting Achievements (Please specify international and national competitions)</p><p>Sporting Aims & Ambitions (Please specify Short-term and Long-term goals)</p><p>Why should you be awarded a Sport Scholarship? </p><p>Additional Information (What Sport Science support have you previously received, Injury information) Nottingham Trent University 2016-17 Sport Scholarship Application Form</p><p>Media Evidence</p><p>Please accompany your application form with the following:</p><p> 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</p><p>N.B. Only the following sports are required to submit Video Footage:</p><p>- Basketball - Cricket - Football - Futsal - Hockey - Volleyball Reference Details (Coach or NGB Contact) </p><p>Name </p><p>Position Club or NGB</p><p>Address</p><p>Email Tel</p><p>PLEASE NOTE: </p><p>Applications will not be considered without a reference and either a student ID or UCAS number and a supporting statement. </p><p>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.</p><p>Declaration (Applicant)</p><p>I certify that the information in this application is correct to the best of my knowledge:</p><p>Signed Date</p><p>Page 3 of 3 Edited by AB on 27.03.12</p>