PURSUIT OF EXCELLENCE COME FLY WITH ME LEGACY FUND APPLICATION

Applicant’s Information: Fields that have an asterisk(*) must be provided or application will not be considered complete.

* Name of Applicant: * Are you over the age of 21? Yes No

* Mailing Address: * Application Date:

* Sport:

* Division/Category

* City:

* Postal Code:

* Phone :

What is your provincial/national/international ranking?

Please list your achievements/awards and the date they were achieved.

Award: Date Achieved:

Please provide a brief description of your competition and training plans for the next 1-3 years. Include

details of your travel schedule. Conclude the section by stating your performance goals for this period. If

you need more space please attach additional pages.

Note: Sport must be recognized by a provincial /national sport organization

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Please describe any other financial assistance you are receiving:

Please provide an individual goal statement outlining short and long term goals and objectives. If you

need more space please attach additional pages.

NOTE: Successful applicants must have come through the Grande Prairie Development System and be going on to World or Olympic competition. Applications for coaching scholarships will only be considered for volunteer coaches.Application must also include: • Letters of support from Coach/Mentor• Letter from National Sport Association confirming membership

Accountability report template will be provided upon approval of funding

If the application is denied, applicants may also appeal the funding application to the Community Living Committee within 30 days of notification from Administration.

REPORTING REQUIREMENTS

Once you click on the SUBMIT FORM button you agree that all information submitted on this application is true and accurate. You can also attach the required documents for the Come Fly With Me Funding Application via email.

FORM SUBMISSION

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RETURN TO:

Sports Development, Wellness and Culture Information Desk

Phone: (780) 830-7090

Email: pursuitofexcellence@cityofgp.com

Social Media: facebook.com/gprecandsport

Important: If you don't receive a confirmation email when you submit your application online,

please contact City Administration directly by phone at (780) 830-7090.

DISCLOSURE

Application Date: Date Received:

FOR OFFICE USE ONLY

This personal information is being collected under the authority of Section 33(c) of the Freedom of Information and Protection of Privacy Act (FOIP Act), and will be used to administer the applications brought forward for consideration for funding from the City of Grande Prairie. It is protected by the privacy provisions of the Freedom of Information and Protection of Privacy Act. If you have any questions about the collection of information please contact the City of Grande Prairie FOIP Coordinator at 780-538-0300.

The use of the your / your child’s name, photos, videos and comments in the City of Grande Prairie newsletter, website pages, social media, and other media publications. Yes No

The use of your / your child’s name and / or photograph collected for the purpose of recognizing grants, bursaries, awards or prizes your child may be eligible for.

I understand that I can withdraw revoke my consent to the uses listed above at any time, in writing, to the Sports Development, WeWellness and Culture department at culture@cityofgp.com.

Under 18 Parental Consent:

I _____________________ agree to the collection of Personal Information for _____________________ (parent name) (child’s name)

and that the information collected may be used for the items I have agreed to above.

Over 18 Applicant Consent:

I _____________________ agree to the collection of Personal Information and that the information (applicant name)

collected may be used for the items I have agreed to above.

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