Please indicate which scholarship you are applying for

CCCU Sport Scholarship, State sport(s)

Other Scholarships:

Canterbury Cricket club

Canterbury Rugby Club

Canterbury Ladies & Men's Hockey Club

Old Bordenian Hockey Club

Maidstone Hockey Club

Degree programme applied for:

UCAS No:

Surname:

Forename:

D.O.B (day/month/year):

Nationality:

Male
Female

Address (Home):

Address (Term time - if applicable):

Telephone:

Mobile:

Email:

Representation (Please state current level of sporting honours)

Representative Honours: Please give details of current level of sporting honours including County, Regional or International

Current training schedules and venue (home club):

Performance: Please state your highest achievements over the last three years, most recent first including dates:

Ambitions: Please advise of your ambitions and goals for the future. If appropriate please express selections, rankings and medals:

Costs: Please itemise the main costs in your sport:

Please state if you are receiving any sports related financial support through grants, awards or sponsorship. If so please state provider and level of support given:

In no more than 200 words please state why you think you should be considered to be on the sport scholarship scheme, and what contribution you can make to University sport and sport club (where applicable):

Sporting References: Please provide names, addresses and contact numbers of two coaches / administrators to whom reference may be made to support your application:

Reference 1:

Reference 2:

Where did you originally hear about the sports scholarship scheme?: