Trafford Active Fund Supported By Xtra Mile Events Survey

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* 1. Please confirm whether you are applying as-

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* 2. Forename (s)

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* 3. Surname

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* 4. Date of Birth

Date / Time

Date

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* 5. Age

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* 6. Home Address

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* 7. Postcode

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* 8. Telephone

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* 9. Mobile

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* 10. Email Address

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* 11. Sport

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* 12. Club

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* 13. School/College/University (if applicable)

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* 14. What level are you currently competing at in your sport? Please give details of any teams you have represented.

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* 15. What have been your main sporting achievements in the last 2 years?

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* 16. What are your sporting goals for the coming year?

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* 17. What are your sporting goals for the next 3 years?

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* 18. If you are successful with your application how will the funding help you to achieve your goals?

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* 19. The athlete fund will prioritise athletes with the greatest financial need. Please give any relevant information on financial need (e.g. receipt of family-tax, one or more parent is not currently employed, etc.)

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* 20. Have you received funding for your sport in the last 12 months?

Yes

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* 21. If yes please list below where the funding was from, the amount of the funding and the date received

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* 22. Please provide below a breakdown of the costs you are applying for. Please detail the items required (Equipment, Training Fees, Competition Fees, Travel and subsistence, Sports clothing, other costs) a description of the item and the cost.

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* 23. If applying as an organisation promoting increased activity, please expand on the impact of your project? (250 words maximum)

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* 24. Declaration:

I am the above named applicant

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* 25. Declaration:

I certify that the information contained in this application is correct

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* 26. Declaration:

If the information changes in any way I will inform Trafford Council accordingly

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* 27. Declaration:

I give permission for Trafford Council to contact me by phone, post or e-mail with information about its activities and funding opportunities

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* 28. Declaration:

My details can be used for promotional purposes should this request be successful

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* 29. Declaration:

I will use this grant for the purposes stated in question 23

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* 30. Declaration:

I will not use the grant for any other purpose without contacting Trafford Council in order to seek authorisation

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* 31. Declaration:

I will keep receipts from any purchases made with this grant and will complete a monitoring report when requested from Trafford Council.