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2021 Athletic Excellence Fund Application
Select the program(s) below that you are applying for. Please
review the guidelines to ensure that you qualify for the program(s)
you are selecting as you may be eligible for more than one
program.
Premier’s Athletic Award Team Gushue Elite Athlete Assistance
(National Team Athletes only)
Sport NL Scholarship
Name of Sport (Primary):
Are you applying as a: Athlete Coach/Official (eligible for
Sport NL Scholarships only)
Are you a professional athlete? (Professional athlete is defined
as someone receiving compensation for competing in their sport and
the sport is their primary profession)
SECTION 1: General Information
Name: Date of Birth:
Gender: Telephone:
Full Mailing Address:
Parent’s/Guardians Name:
Telephone:
E-mail (can be athlete and/or parent/guardian- please note all
correspondence relating to thisapplication will be sent to this
address):
Government of Newfoundland and LabradorDepartment of Tourism,
Culture, Arts and Recreation
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SECTION 2: Athletic Performance January – December 2020
COMPETITIONSName of Event Type of Competition
(Championship or Invitational)
Placing Number of Teams and/or Competitors
Date
TRAINING CAMPS Team Name Type (Open or Invite
only) Number of athletes at
camp
Date
CANCELLED EVENTS DUE TO COVID-19 (Competition and Camps)Name of
Event Type
(Competition or Training Camp) Date
Department of Tourism, Culture, Arts and RecreationGovernment of
Newfoundland and Labrador
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SECTION 3: Awards/Honors/Accomplishments in 2020
Title Date Placing
SECTION 4: 2021 Competition Schedule
Name and Location of Competition(s)
Type of Competition Championship or
Invitational)
Date
Department of Tourism, Culture, Arts and RecreationGovernment of
Newfoundland and Labrador
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SECTION 5: Budget January – December 31, 2020
List your sport expenditures (direct out of pocket expenses) and
revenues (Scholarships, Sport Canada funds, prize money, appearance
fees, club funding, corporate support, etc.) for the 2020
competition season.
Expenditure(s) Revenue
Item Cost
SECTION 6: Educational Status - This section is to be completed
by Team Gushue and Sport NL Scholarship applicants only.
An official transcript for the most recent completed year or
term of study ‒ January 01, 2020 to December 31, 2020 must
accompany your application.
If you were a high school student until June 2020, we only
require your official transcript for the Fall semester of your
post-secondary studies.
Have you attached an official transcript? Yes No
Name of Post-Secondary Institution:
Faculty/ Degree Program:
Major:
Present Status (year or current number of credits):
Are you a part-time or full-time student? Full-time
Part-time
Department of Tourism, Culture, Arts and RecreationGovernment of
Newfoundland and Labrador
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Are you enrolled in the above indicated post-secondary
institution’s current semester (January to May 2021)?
Yes No
Year of Graduation from High School:
SECTION 7: Privacy Notice
The personal information in this form is being collected under
the authority of section 61(c) of the Access to Information and
Protection of Privacy Act, 2015, for the purpose of program
administration and assessing the merits of each funding
application. Please note that the information you provide can be
subject to an Access to Information request. If you have any
questions about the collection, use and disclosure of your personal
information, please contact the Access and Privacy Coordinator,
Department of Children, Seniors and Social Development at
709.729.7000.
SECTION 8: Athlete’s Declaration
I hereby declare that all of the above information, to the best
of my knowledge, is true and complete. If selected, in return for
any assistance provided under the Athletic Excellence Fund Program,
I will undertake to fulfill all training commitments and I agree to
compete for the Province of Newfoundland and Labrador in all
eligible competitions. Recipients of scholarships will permit Sport
NL and/or the Government of Newfoundland and Labrador to publish
their names, city or town of residence, and/or photographs for
purposes relating to the Athletic Excellence Fund.
Application’s Signature Date
SECTION 9: Coach’s Declaration - for completion by coaches only
(Athlete responsible for obtaining coach declaration)
This will confirm that the above named applicant is presently
training and /or competing in the identified sport under the
guidance and training of the undersigned. Coach’s Name:
Telephone: Email:
Coach’s Signature Date
Department of Tourism, Culture, Arts and RecreationGovernment of
Newfoundland and Labrador
SECTION 6 – Educational Status (cont'd)
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SECTION 10: Provincial Sport Organization Declaration – for
completion by PSO only
Name of PSO:
Date application received by the PSO:
Athlete’s ranking for assistance within your sport based on the
Premier’s Athletic Awards Criteria.
President Signature (or other PSO Executive Member)
Date
SECTION 11 – Checklist
Ensure that all areas of your application are completed.
Incomplete applications will not be accepted.
SECTION 1: General Information
SECTION 2: Athletic Performance
SECTION 3: Awards/Honors/Accomplishments in 2020
SECTION 4: 2021 Competition Schedule
SECTION 5: Budget
SECTION 6: Educational Status
Official Transcript – required for Team Gushue and Sport NL
Scholarship applicants
only
SECTION 8: Athlete’s Declaration
SECTION 9: Coach’s Declaration
Applications are due to the respective Provincial Sport
Organization by Wednesday, January 27, 2021
Contacts: Sport NL Scholarship- Candice Petten
([email protected]), 576-4629 Premier’s Athletic Award/Team
Gushue/Elite Athlete Assistance- Billy Taggart
([email protected]), 729-6291
Department of Tourism, Culture, Arts and RecreationGovernment of
Newfoundland and Labrador
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mailto:[email protected]:[email protected]
Date of Birth: Gender: Telephone: Full Mailing Address:
ParentsGuardians Name: Telephone_2: Email can be athlete andor
parentguardianplease note all correspondence relating to this
application will be sent to this address: Name of EventRow1: Type
of Competition Championship or InvitationalRow1: PlacingRow1:
Number of Teams andor CompetitorsRow1: DateRow1: Name of EventRow2:
Type of Competition Championship or InvitationalRow2: PlacingRow2:
Number of Teams andor CompetitorsRow2: DateRow2: Name of EventRow3:
Type of Competition Championship or InvitationalRow3: PlacingRow3:
Number of Teams andor CompetitorsRow3: DateRow3: Name of EventRow4:
Type of Competition Championship or InvitationalRow4: PlacingRow4:
Number of Teams andor CompetitorsRow4: DateRow4: Team NameRow1:
Type Open or Invite onlyRow1: Number of athletes at campRow1:
DateRow1_2: Team NameRow2: Type Open or Invite onlyRow2: Number of
athletes at campRow2: DateRow2_2: Team NameRow3: Type Open or
Invite onlyRow3: Number of athletes at campRow3: DateRow3_2: Team
NameRow4: Type Open or Invite onlyRow4: Number of athletes at
campRow4: DateRow4_2: Name of EventRow1_2: Type Competition or
Training CampRow1: DateRow1_3: Name of EventRow2_2: Type
Competition or Training CampRow2: DateRow2_3: Name of EventRow3_2:
Type Competition or Training CampRow3: DateRow3_3: Name of
EventRow4_2: Type Competition or Training CampRow4: DateRow4_3:
TitleRow1: DateRow1_4: PlacingRow1_2: TitleRow2: DateRow2_4:
PlacingRow2_2: TitleRow3: DateRow3_4: PlacingRow3_2: TitleRow4:
DateRow4_4: PlacingRow4_2: TitleRow5: DateRow5: PlacingRow5:
TitleRow6: DateRow6: PlacingRow6: Name and Location of
CompetitionsRow1: Type of Competition Championship or
InvitationalRow1_2: DateRow1_5: Name and Location of
CompetitionsRow2: Type of Competition Championship or
InvitationalRow2_2: DateRow2_5: Name and Location of
CompetitionsRow3: Type of Competition Championship or
InvitationalRow3_2: DateRow3_5: Name and Location of
CompetitionsRow4: Type of Competition Championship or
InvitationalRow4_2: DateRow4_5: Faculty Degree Program: Major:
Present Status year or current number of credits: I hereby declare
that all of the above information to the best of my knowledge is
true and complete If selected in return for any assistance provided
under the Athletic Excellence Fund Program I will undertake to
fulfill all training commitments and I agree to compete for the
Province of Newfoundland and Labrador in all eligible competitions
Recipients of scholarships will permit Sport NL andor the
Government of Newfoundland and Labrador to publish their names city
or town of residence andor photographs for purposes relating to the
Athletic Excellence FundRow1: I hereby declare that all of the
above information to the best of my knowledge is true and complete
If selected in return for any assistance provided under the
Athletic Excellence Fund Program I will undertake to fulfill all
training commitments and I agree to compete for the Province of
Newfoundland and Labrador in all eligible competitions Recipients
of scholarships will permit Sport NL andor the Government of
Newfoundland and Labrador to publish their names city or town of
residence andor photographs for purposes relating to the Athletic
Excellence FundRow1_2: EmailRow1: Name of PSO: Date application
received by the PSO: Athletes ranking for assistance within your
sport based on the Premiers Athletic Awards Criteria: Date: Check
Box1: OffCheck Box2: OffCheck Box3: OffCheck Box4: OffCheck Box5:
OffCheck Box6: OffGroup8: OffAthletes ranking for assistance within
your sport based on the Premiers Athletic Awards CriteriaRow1: Name
of Sport: Name: ItemRow1: CostRow1: RevenueRow2: ItemRow2:
CostRow2: RevenueRow3: ItemRow3: CostRow3: RevenueRow4: ItemRow4:
CostRow4: RevenueRow5: ItemRow5: CostRow5: ItemRow6: CostRow6:
RevenueRow7: ItemRow7: CostRow7: RevenueRow8: Name of PostSecondary
Institution: Coachs Name: TelephoneRow1: Text9: Text10: Year of
Graduation from High School: RevenueRow6:
