Lords Taverners NNSW | » Apply for a Sporting Grant

Applicant Details

Name of person for whom application is made.*

First Last

Date of Birth*

Gender

Male
Female

Address*

Street Address City State / Province / Region ZIP / Postal Code Country

Phone (Home)

Mobile Phone

Email

Is the applicant under the age of 18?*

Yes (please provide Parent/Guardian details below)
No

Have you received a LTNNSW Sporting Grant before?

Yes
No

If yes, in what year/s?

(Please note you can only apply for a Sporting Grant every THREE (3) years.)

Parent/Guardian Details

Parent/Guardian Name*

First Last

Parent/Guardian Phone (Home)

Parent/Guardian Mobile Phone

Supporting Person Details

e.g. Coach, Teacher. Must not be Parent or Guardian

Name of Person Supporting Application*

First Last

Phone of Supporting Person

Email of Supporting Person

Relationship to Applicant*

It is the responsibility of the Applicant to ensure the submission of a Supporting Statement. Applications without Supporting Statements will not be considered. (Persons writing Supporting Statements for Applicants from Postcodes beginning with 23.. MUST also be from the same or nearby postcodes.)

Application Questions

Every question must be answered. Applicants are advised that the more information provided, the better the chance of the application being approved and greater financial assistance may be approved.

1. For what sport are you seeking financial assistance:*

2. Please tick any box below that applies to you (you can tick more than one box):*

Financial Hardship Details*

Applicant Disability Details*

Parent/Guardian Disability Details*

Geographical Isolation Details*

Other reasons for seek assistance details*

3. Please provide details about what you require the grant funds for (you can tick more than one box):*

Training for representative competition
Competing
Registration
Travel and accommodation
Equipment and gear
Coaching
Medical expenses.
Other (please provide details below)

Other funding details*

4. What is the total cost to you (to nearest dollar)?*

Please enter a number from 0 to 9999.

5. Please provide details of the level of competition you are training for or competing in:*

International
National
State
Regional
Local (please provide details below)

Local competition details*

6. If you have to travel to train in this sport how far do you have to travel?*

I do not have to travel outside of my home town
I have to travel up to 150kms
I have to travel 150-300 kms
I have to travel 300-500 kms
I have to travel greater than 500kms

7. Where is the competition or event located?*

8. How did this opportunity arise?*

You were selected from a competitive selection process by coaches and selectors.
You or your team has progressed through rounds of competition.
This is a private skills development event/tour open to anyone who wants to go.
Other (You must provide details below)

Other opportunity details*

9. Details about the applicant’s achievements in this sport to date:*

(please provide details)

10. Please outline below how much financial assistance you are requesting from Lord’s Taverners Northern NSW, and how you intend to spend the funds:*

11. Give dates on which the events applicable to this application will be held:*

(please provide details)

12. Date by which funding is required:*

We prefer to pay grant moneys directly into your bank account. Is this acceptable to you?*

Yes (please provide details below)
No

BSB*

Bank Account Number*

Name on Bank Account*