Westway Trust Sports Bursary - Application form

Westway Trust Sports Bursary - Application form Section 1 – Personal Details Forename: Address:

Surname: Postcode:

Date of birth: (DD/MM/YY) Telephone Day: Mobile:

Telephone Evening: Email:

Do you live in Royal Borough of Kensington and Chelsea (RBKC)? Yes

No

If you are employed please give details Name of employer: Address:

Postcode:

Telephone: Job Title: If you are in education please give details Name of school/institution: Address:

Postcode:

Telephone: Course of study/Year: Section 2 - Sporting Activities/Training What type of sport/event do you participate in? Please tell us about your current participation in this sport or your sporting achievements in the last 12 months.

Where and how often do you train?

Please give the name of your club/session and coach and address (if not at 1, Crowthorne Rd or 3-5 Thorpe Close centres)

What sessions/equipment/course/competition is your application for?

Will you be representing Westway in the competition or coaching at Westway after gaining qualification? Yes

No

Will you be wearing Westway merchandise/uniform? Yes

No

Section 3 – Other Assistance Have you received any financial assistance from a Westway sports bursary or any other organisation to support your sports training within the past 2 years?

(As long as you continue to be eligible for assistance from the fund, you may re-apply in the future. However please bear in mind that funds available are limited).

Amount: Amount: Amount:

Organisation: Organisation: Organisation:

Date: Date: Date:

Section 5 – Declaration I certify, to the best of my knowledge and belief, the information contained in this application is true. I understand that my club/coach/tutor maybe approached for the verification of any particulars and report on the application. Signature

Date

Counter-signature of parent/guardian, if applicant is under 18years Signature

Date

Please use this space to give any further information to support your application:

Proof of eligibility documents required:  Copy of receipt of Universal Credits  Proof of address  copy of course booking or equipment quotations Please return your completed form to: Westway Sports & Fitness Bursary Fund c/o The Sport & Fitness Bursary Committee (Laura Pugh) Westway Sports Centre 1, Crowthorne Road London W10 6RP For more information on Westway Sports & Fitness Bursaries email: [email protected]