Inspiration for Sport
Rowing
APPLICATION FORM
(Please complete application form in BLOCK CAPS)
PERSONAL DETAILS
NAME: _____________________________________________
HOME ADDRESS: _____________________________________
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HOME NUMBER: _________________________ DATE OF BIRTH: _________________
MOBILE NUMBER: ________________________EMAIL ADDRESS: ___________________________
CLUB or SCHOOL NAME: ______________________________________
CLUB or SCHOOL ADDRESS: _______________________ SCHOOL NO: _________________
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GCSE / JUNIOR CERT RESULTS: (Please enclose a copy of your GCSE / JNR CERT results)
SUBJECT GRADE SUBJECT GRADE
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AS LEVELS or LEAVING CERT (If repeating)
SUBJECT GRADE SUBJECT GRADE
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A LEVELS / LEAVING CERT (PREDICTED)
SUBJECT GRADE SUBJECT GRADE
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Interested in going to University? YES/NO Which subject area(s) ________________________
Rowing profile
(Tell us about your rowing career to date)
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Your Coaches
Name: Ph No: e-mail:
Name: Ph No: e-mail:
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ROWING ACHIEVEMENTS:
Please list any rowing results you have recorded over the last few years which you believe may be of interest to us.
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OTHER INFORMATION:
Please let us know why you should be awarded a place on this one day Inspiration for Sport Event (Rowing) at Queen’s University Belfast, and what course you would like to pursue.
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PLEASE RETURN THIS APPLICATION FORM NO LATER THAN WEDNESDAY 2 OCTOBER 2013 AT 12PM.
RETURN TO;
Natalie Chambers
Queen’s Sport
Physical Education Centre
Botanic Park
Belfast BT9 5EX
or
e-mail: n.chambers@qub.ac.uk
Enquiries to; Mick Desmond m.desmond@qub.ac.uk +44(0)7588277121 or Anthony McGrath a.mcgrath@qub.ac.uk
QUB open day Sunday 6th October - anyone possibly interested in applying to Queen’s next year please contact Keith Leighton Club Captain.
September 22nd, 2013
