University of Cambridge Athlete Performance Programme (UCAPP) Application Form

Title *

Mr

Miss

Ms

Other

First Name *

Last Name *

Date of Birth *

Day

Month

Year

Home Post Code *

Home Address *

Term Address *

Term Post Code *

Contact Number *

Email Address *

Alternative Email Address

Emergency Contact Name *

Please provide details of an emergency contact

Emergency Contact Number *

Relationship with Emergency Contact? *

Do you consider yourself to have a disability? *

Yes

No

Prefer not to say

If you would like to provide us with information about a disability, we will use this information to ensure we deliver a safe and appropriate service.

If yes

Health Condition/Long Term Illness

Hearing Impairment

Learning Disability

Physical Impairment/Mobility Issues

Visual Impairment

Other Type of Disability

Are you currently or have you recently suffered any injury which may affect your athletic performance? *

Yes

No

Please give brief details below

College *

Academic Details

Course *

Faculty *

Course Leader *

Tutor *

Course Length *

Year of Study *

Your Sport *

Sport Details

Years in Sport *

Current Club

Coaches Email

Coaches Contact Number

NGB Contact

Current Level

Current Training Hours per week - Sport Specific *

Current Training Hours per week - Cross Training *

Current Training Hours per week - Strength & Conditioning *

Sporting achievements over the last 2 years (to include dates, levels)

Goals and Targets for the next year (to include both University and External clubs)

Are you committed and able to represent the University at all relevant training sessions, competitions and events? *

Yes

No

Please list any coaching qualifications you currently hold (to include level and date qualified)

Do you currently receive any other financial support through sponsorship, NGB awards, grants or professional/semi-professional clubs? *

Yes

No

If yes, please provide details

Reference 1 Name *

Please provide the details of two referees who will support your application. (One reference must be your current coach or NGB contact)

Reference 1 Relationship *

Reference 1 Address *

Reference 1 Telephone *

Reference 1 Email

Reference 2 Name *

Reference 2 Relationship *

Reference 2 Address *

Reference 2 Telephone *

Reference 2 Email *

Please complete your supporting statement. In your own words, why do you wish to be considered for UCAPP? *

This statement must be no longer than 500 words.

I understand that the University will hold my personal details on its secure database and that it may use them in case of an emergency or in case it needs to contact me; this may be by telephone, email or text message. *

Yes

In general, we use your personal information in order to deliver our contractual obligations to you as a user of our service and to monitor sales and use of our facilities. We use any disability information you supply to monitor the use and safety of our service and you do not have to provide it to us. For more information about how we handle your personal information, and your rights under the data protection legislation, please see https://www.information-compliance.admin.cam.ac.uk/data-protection/general-data

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University of Cambridge Athlete Performance Programme (UCAPP) Application Form

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