Coaching Scholarship Application Form – Midwest Academy of Sport

Name*

First Last

Mobile phone number*

Address

Email address*

Applicants email address

Date of birth of applicant

Gender*

Male
Female

Applicant identifies as being of Aboriginal or Torres Straight Island descent?

Yes
No

Shire of residence*

Included shires: Carnamah, Chapman Valley, Coorow, Cue, Greater Geraldton (includes Mullewa), Irwin, Meekatharra, Mingenew, Morawa, Mount Magnet, Murchison, Northampton, Perenjori, Sandstone, Three Springs, Wiluna and Yalgoo. (Athletes who go to a boarding school outside of the listed LGAs are not eligible for a scholarship).

Sport in which you coach or officiate?*

Current coaching qualifications? i.e Level 1 or 2 and when achieved?*

State Sporting Association supporting the application (E.g. WACA, Basketball WA, Athletics WA, Football West)*

State Sport Association (SSA) approving this application (Contact with and approval from the SSA must be obtained by the applicant prior to submitting this application). The SSA must be made aware of and support the applicant with the conditions of the scholarship – if unsure please ensure they contact MWAS CEO on 0487 846 283 or email mwas@sportshouse.net.au for details.

Name of contact person*

Please provide the name of the person who has verified and supports the application on behalf of the SSA. This person will be required to liaise with the MWAS CEO throughout the period of the scholarship.

Position held at the SSA

The position held at the SSA could include the High Performance Manager, State Team Coordinator or Development Pathway Coach?

Email address*

Telephone numbers*

Please include office and mobile numbers.

I confirm that the High Performance Manager or approved representative of the SSA and/ or the RSA endorse and support this application.*

Yes, I confirm

The SSA must approve this application and support it.

Coaching Applicants resume and qualifications*

Please provide a statement clearly demonstrating your relevant qualifications (personal, coaching or work related), your current coaching resume including teams/athletes you are currently coaching and at what level are they playing? (bullet-points are acceptable).

Coaching goals for scholarship period*

Please identify your coaching goals for the scholarship period if accepted into the program (bullet-points are acceptable). Use the SMART principles - Specific, Measurable, Achievable, Realistic and Time bound. (This will help guide your development planning).

I certify that the information provided in this application is true and correct.*

Yes, I confirm the information that I have provided in this application is true and correct.