2019 Para-Cycling Next Gen Application Form
Vision...To create a World Class Para-Cycling program that will be medal competitive by Tokyo 2020 Olympic Games. Underpinning this vision will be a committed NextGen program for emerging talent supported by world-class infrastructure and ambitions creating a long-term career pathway towards international competitiveness. APPLICATION DEADLINE: 17:00 PDT, FRIDAY, OCTOBER 12TH, 2018.
APPLICANT INFORMATION
Name
First Name
Last Name
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Date of Birth (MM-DD-YYYY)
-
Month
-
Day
Year
Date
Height
Centimetres
Weight
Pounds
APPLICATION BASED ON THE FOLLOWING CRITERIA
Have you ever raced for Team Canada?
Yes
No
Para
Track
Road
MTB
Cross
Have you ever met Sport Canada Carding criteria?
Yes
No
If yes, to the question above, please provide details:
CCES / UCI Whereabouts list?
Yes
No
Para-Cycling NextGen core group:
TT or IP Cycling Canada Track Time Development Standards
TT Cycling Canada Development Road Standard
Discretionary Advise from NextGen or HP coach
If applicable, please provide details regarding above:
REFERENCES (PREVIOUS COACH AND PROGRAM)
Coach Name
First Name
Last Name
Company
Email
example@example.ca
Phone Number
-
Area Code
Phone Number
Club / Team
Level of racing
Number of race days (2018)
Km (2018)
1 minute Critical Power
Watts
Comments / Where / When / Power Meter Used
Regarding 1 minute Critical Power
4 minute Critical Power
Watts
Comments / Where / When / Power Meter Used
Regarding 4 minute Critical Power
20 minute Critical Power
Watts
Comments / Where / When / Power Meter Used
Regarding 20 minute Critical Power
PREVIOUS SIGNIFICANT RESULTS
Time Trials, Road Race, or Track (Provide at least the 2 previous seasons if possible)
Significant Result 1
Please provide Event Name, Date, and Result
Significant Result 2
Please provide Event Name, Date, and Result
Significant Result 3
Please provide Event Name, Date, and Result
Significant Result 4
Please provide Event Name, Date, and Result
Significant Result 5
Please provide Event Name, Date, and Result
Significant Result 6
Please provide Event Name, Date, and Result
Submit
Should be Empty: