Athlete Scholarship Application Form – Midwest Academy of Sport

Name*

First Last

Mobile phone number (athletes number)*

Address

Email address*

Applicants email address - this will be used to correspond with the athlete.

Parents / guardian's names*

If applicant is under 18 please advise parent / guardian names.

Parents preferred contact numbers

Parents email address/es*

Preferred contact address for information to the parents

Date of birth of applicant*

(Must be aged at least 13 years on at least one day during the scholarship period)

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).

Type of scholarship

Please select the type of scholarship you are applying for:- Athlete Scholarships: Includes services such as strength and conditioning, sports science, nutrition advice, sports psychology, technical and tactical coaching and access to elite facilities and camps (Please note that there are two levels of scholarships available to athletes if selected and you will be notified which category you fall into). Coach Development Scholarships: Includes year-round professional development programs, events, seminars and access to elite athletes, coaches and teams. Official Development Scholarships: Includes a year-round professional development plan and opportunities for funding (if available).

Sport in which you participate in or play?*

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

State Sport Association (SSA) approving this application (You must make contact with and obtain approval from the SSA prior to submitting this application). The SSA must be made aware of and support the applicant with the conditions of the scholarship and verify that the applicant is part of an identified talent pathway – 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.

Who is / are the athlete's coach / coaches?

Please name the coaches that will provide the day to day technical coaching in your sport. Also provide their contact details.

Athlete applicants*

Please provide a brief statement that demonstrates how you (the applicant) meets the MWAS selection criteria. This means please write about your current achievements to show why you should be selected into MWAS i.e the highest level of team selected into this year or individual results achieved. Please also show other sports played and anything else you feel relevant to the application. The athlete selection criteria can be viewed by copying and pasting this link to your browser – https://www.mwaswa.com.au/index.php?id=126

Athlete applicants - Goals for scholarship period*

Please provide your personal goals for the scholarship period (if you are successful) and ensure you identify how you will know if you have achieved them. Use the SMART principle -Specific, Measurable, Achievable, Realistic and Time bound.

Name of person completing this application

If not completed by the applicant (i.e parent / guardian)

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.