DISPENSATION APPLICATION FORM

Please complete and submit this form if you are seeking dispensation for state team selection on the basis you are unable to meet the qualification requirements as outlined in the TTQ Selection Policy for state team selection.

For any request for dispensation to be considered, this application must be submitted by or before the closing date for the relevant QLD Closed Championships being held in the same year a player is seeking dispensation for selection.

To be eligible for selection in a state team, please refer to section 5.2 (selection eligibility) of the TTQ Selection Policy below.

Click here for further information regarding changes to the selection policy and the modified selection cycle in 2026.

Special dispensation in relation to the eligibility criteria (see selection policy) may be given at the discretion of the TTQ Board of Management. The request must be received in writing prior to the close of entries of the relevant state championships, or in the case of rankings, prior to 30 September of the year in which the ranking is requested. Valid reasons for not meeting these criteria may include, but are not limited to:

1. Representing Australia;

2. Serious illness or injury;

3. Participation in a national table tennis development program;

4. Examinations scheduled during the relevant state championships;

5. Death in the immediate family;

6. Catastrophic act of nature.

Enter your full name below.

First NameLast Name

Name of Primary Club/Association

National ID number

Address

Street Address

Street Address Line 2

CityState

Post Code

Date of Birth

Date

Phone Number

Please enter a valid phone number.

Email

example@example.com

Please tick the qualifying events from the list below you are seeking dispensation from.

Please add any additional information regarding your application for dispensation from participating in any of the selected qualifying events above.

Please document the nature of Illness, injury or extenuating circumstances below:(please include date of onset or when situation became known and likely duration. For conflicting events, please detail the date of event, dates and any relevant travel arrangements)

Please document tournaments and results played or to be played prior to the National Championships in the year you are seeking dispensation. These may include Interstate or Overseas events; local fixtures; other training activities or events.

Please select the option below to confirm all the information provided in this application are true and correct, and you have read and understand the TTQ Selection Policy

YesNo

Please attach any documents here to support your application (eg medical certificate, copy of flight itinerary, examination time-table for medical procedures etc)

Date of application.

State Team Selection Request for Dispensation Form

Applicant Information

Dispensation Information

Commitment to Qualifying

Acknowledgement

Supporting Documents