1) Personal Details
2) Course
3) Sporting Details
4) Performance level
5) References

Personal Details

Full Name *
Gender *
Date of Birth *
Nationality *
Sport *
Home Address *
Term Time Address *
Post Code *
Home Tel
Mobile Tel *
Email Address *
UCAS number/Student number *

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Details of University of Sunderland courses applied for

Current or prospective student? * Current Prospective
Have you applied for Elite Athlete Entry status in the past? * Yes No
If yes, please state when

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Sporting Details

Home Club *
Name of Governing Body
Contact within Club (who may be contacted in relation to this application)
Name *
Position *
Contact Number *
Email Address *
Name of Main Coach *
Contact Number *
Email Address *

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Performance Level

Level TICK Supplementary Information e.g age group, event/international attended and in what year(s), number of times selected.
Age Group County
Senior County
Age Group Inter Provincial
Age Group International (NI/IRE/GB)
Senior Inter Provinical
Senior International (NI/IRE/GB)
Commonwealth Games/Championships
World/European Championships
Olympic/Paralympic Games
What do you consider to be your most outstanding sporting performance in the last 18 months (please provide details of result, times, distances, scores etc. as appropriate). *
Please provide details of your sporting goals *
Please provide details of how you would benefit from accessing support services on entry to Sunderland *
What level of contribution and commitment are you willing to make to sport at the University of Sunderland? *

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Please provide details of two people qualified and willing to act as a referee e.g. Club Official, Coach, Manager, Teacher or governing body representative.
Name *
Position *
Home Address *
Telephone Number *
Email *
Name *
Position *
Home Address *
Telephone Number *
Email *
Declaration *
I certify that the information that I have stated on this Application Form is correct. I understand that the University, at its discretion, may withdraw any offer of a place made under the conditions of the Talented Athlete Entry Scheme (and prior to my registration on a course of study), where information so stated is subsequently found to be incorrect or misleading. In addition, where information is found to be incorrect or misleading after I have registered on a course of study and where I would not otherwise have been eligible for entry to that course, I understand that the University may consider discontinuing my studies.
Yes [ ]

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