Athlete Development Program (ADP)

Athlete Development Program (ADP) - Application Form
Personal Details
Name*

First NameLast Name
Date of Birth*

MonthDayYear
Date
Pronoun*

He/HimHer/SheThey/Them
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Student Number*
Course Enrolled In*
Year Course Commenced*
Expected Course Completion*

Who do you currently compete for?
Club*
Level/Division*
Coach*
Coach Phone Number*
Please enter a valid phone number.
Coach Email*
example@example.com
Significant results over the past 18 months

(Please provide 3)
1.*
2.*
3.*
Please provide two contacts that can support your application and are prepared to be sporting referees on your behalf
Contact Referee 1:
Name*

First NameLast Name
Role*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.
Contact Referee 2
Name*

First NameLast Name
Role*
Email*
example@example.com
Phone Number*
Please enter a valid phone number.

Athlete Statement
Please outline in no more than 300 words your aims and goals, both academically and sporting, outlining how the benefits offered with the program will assist you to achieve them.*
Please upload a high quality sporting photograph (quality no less than 1024 x 768)*

Cancelof
The Athlete agrees to:
1. Act in a sporting and professional manner whilst representing Flinders University.

2. Attend a minimum of two events during the period of this agreement for purpose of promotion of the Athlete Development Program, or sport and sporting events.

3. Provide regular updates on competition schedules and results, as applicable.

4. Where possible, represent Flinders University at UniSport Australia sanctioned events.

5. Provide Flinders University Sport and Fitness with a sporting picture for promotional purposes.

6. Have their profile including an approved photograph on the Flinders University Sport and Fitness website.

7. At the conclusion of the year, provide a testimonial on the program.

8. Abide by Flinders University policies, procedures and guidelines.
Declaration Statement
I First Name* Last Name* wish to be considered for the Athlete Development Program as indicated and declare that the information on this form is correct and complete. I am aware that the information provided in this statement is governed by the Privacy act 1988, and that it will not be disclosed to any third parties without my consent. I agree to the terms and conditions that are attached to receiving this scholarship.
Date*

DayMonthYear
Date
Signature*

Clear
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Athlete Development Program (ADP) - Application Form

Personal Details

Sport Specific Information

Who do you currently compete for?

Significant results over the past 18 months

Please provide two contacts that can support your application and are prepared to be sporting referees on your behalf

Athlete Statement