DISPENSATION APPLICATION FORM

State Team Selection Request for Dispensation 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.
Applicant Information
Enter your full name below.

First NameLast Name
National ID number
Name of Primary Club/Association
Address

Street Address

Street Address Line 2

CityState

Post Code
Date of Birth

DayMonthYear
Date
Phone Number
Please enter a valid phone number.
Email
example@example.com
Dispensation Information
List the Name of the Event or Events you are seeking dispensation for below:
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)
Commitment to Qualifying
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.
Acknowledgement
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
Supporting Documents
Please attach any documents here to support your application (eg medical certificate, copy of flight itinerary, examination time-table for medical procedures etc)

Cancelof
Date of application.

DayMonthYear
Should be Empty:

State Team Selection Request for Dispensation Form

Applicant Information

Dispensation Information

Commitment to Qualifying

Acknowledgement

Supporting Documents