Canada Futures Coach Mentorship Program

Canada Futures Coach Mentorship Program

Association Financial Support Request Form
Prior to completing this application please confirm with your local association you have their support in applying.
Coach Information
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Phone Number
Email
example@example.com
Association/Club/Team
Example Prince George Minor Softball
Position
Example: Head Coach, Assistant Coach
Age/Category
Example: U15 "A"
Number of Years Coaching
Example: 5
Program Participation Details
Purpose of Participation
Please describe how this opportunity will support your coach development and benefit your club/association in the future.
What Do You Hope To Get Out Of This Program?
In What Ways Will Participation In This Program Contribute To Your Club/Association Involvement?
Is There Anything You Would Like For Us To Know About You?
Estimated Travel & Accommodation Expenses

Expense Category

	Estimated Amount (CAD)
Flights (Will Vary Depending on Destination)
Ground Transportation (Approx $75/Day - Includes: Bus/Van/Fuel/Insurance)
Accommodation (Approx $165/Night - 2 Coaches Per Hotel Room)
Meals (Approx $75/Day)
Additional Expense(s)
---
Canada Futures Mentorship Program Apparel & Admin Costs: $275
TOTAL EXPENSES:

Note:

$1 USD = $1.38 CND

$1 CND = $.72 USD
Any Additional Information You Would Like To Provide?
Support Requested
Total Amount Requested from Association/Club/Team
Coach Contribution (if applicable)
Other Sources of Funding (if any)
Do You Have Any Questions?
I certify that the above information is accurate and that I am requesting financial assistance solely for the purpose of participating in the Canada Futures Coach Mentorship Program. I understand that I am responsible for my own travel insurance and any additional costs.

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Today's Date

MonthDayYear
Date
Please submit the copy you receive to your:

Association President

Association Secretary

Association Treasurer

Association Rep Coordinator
Association Use Only
Date Received

MonthDayYear
Date
Approved Amount
Authorized By (Association President)

First NameLast Name
Authorized By (Association Treasurer)

First NameLast Name
Name Of Authorized Association Representative

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Date

MonthDayYear
Date
Please E-Transfer total amount to:

info@canada-futures.com

If requesting another payment method please email:

jfrei@canada-futures.com
Should be Empty:

Coach Information