Honouring the past, inspiring the future

11th October 2018 – 31st December 2019

2019 Program Informationand Application Form

Applications close Monday 9th July 2018

FUNDRAISING PARTNER PROGRAM SUPPORTER

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Introduction The Sport Australia Hall of Fame’s (SAHOF) vision is to preserve and celebrate the history Australian sport and to excite all Australians to achieve their potential both in sport and life. The SAHOF Scholarship & Mentoring Program is a key opportunity for us to continue to realise our vision.

The Scholarship will provide encouragement and funding for 14 months to help young Australians achieve at the highest level of their sport.

Most importantly, Scholarship holders will enjoy unrivalled access to personal one-on-one mentoring from an Inducted Member; surely no greater way to inspire young sportspeople to fulfil their potential. SAHOF is one of Australia’s most prestigious organisations and represents the pinnacle of sporting achievement in Australia, acknowledging sporting greats who have gone beyond and above their sport to achieve cultural significance. Inductees include Sir Don Bradman AC, Dawn Fraser AO MBE, John Eales AM, Catherine Freeman OAM, Ian Thorpe OAM, Liz Ellis AO, Adam Gilchrist AM, Shane Warne, Layne Beachley AO, Kostya Tszyu, Louise Sauvage OAM and many more.

Inclusions The SAHOF Scholarship & Mentoring Program will consist of:

• One-on-one personal mentoring by an Inducted Member of The SAHOF

• A $5,000 sporting expenses grant

• On-stage presentation of the Scholarship at The SAHOF Induction & Awards Gala Dinner to be held at thePalladium at Crown Melbourne on Thursday 11th October 2018(Travel and accommodation cost for recipient covered)

• SAHOF Scholarship Merchandise Pack

• ‘The Sport Australia Hall of Fame Scholarship Holder’ logo for agreed use

Eligibility Nominations are open to all sportspersons who are:

a) Under the age of 21 years at 31st December 2018

b) An Australian citizen

c) Participating in a sport recognised by the Australian Sports Commission; www.ausport.gov.au

d) Competing at a minimum of international junior level in their chosen sport (where applicable)

e) A member of the Australian junior or senior squad/team in their chosen sport (where applicable)

Previous Scholarship Holders are encouraged to re-apply providing they meet the Scholarship & Mentoring Program Eligibility Criteria.

Please note: The organisers reserve the right to change the conditions of the Scholarship & Mentoring Program. The Scholarship Selection Committee’s decision will be final.

Important DatesClosing date for applications: Monday 9th July 2018 Each Scholarship will apply from 11th October 2018 to 31st December 2019.

Submission Details Please download, complete and save the nomination form and then return to:

Email operations@sahof.org.au

Post The Sport Australia Hall of Fame PO Box 173, East Melbourne, VIC 8002

No reference letters and attachments will be accepted, with the exception of the 45 second video referred to in section 8, question 4. SAHOF will seek additional information from you if required.

FUNDRAISING PARTNER PROGRAM SUPPORTER

Please complete all questions and be concise with your answers within the space provided. Summarised and statistical dot point information is preferred.

CLOSING DATE MONDAY 9th JULY 2018

Section 1 Personal details of Scholarship Applicant

Family Name Given Names Gender:

DOB: Age (as at 31st December 2018)

Country of birth Australian Citizen:

Residential Address

Suburb

State Postcode

Mailing Address (if same as above please leave blank)

Suburb

State Postcode

Phone Mobile Email

Occupation

If student Grade/Degree

School/Uni/Campus

If working Employer

Contact Person Phone

Section 2 Referees - You are required to supply three referees with contact details:

Referee 1: National Sport Organisation Referee 2: Coach (National/Personal) 3: Other - Non Relative

Role Role Relationship

Name Name Name

Email Email Email

Mobile Mobile Mobile

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Yes No

Section 3 Sport

Associated Sport Discipline 1

Discipline 2

Discipline 3

Is the Scholarship applicant a member of the Australian junior or senior squad/team in their chosen sport (where applicable)?

Is the Scholarship applicant competing at a minimum of international junior level in their chosen sport (where applicable)?

Current Rankings as at 1st July 2018

International Senior Ranking International Junior Ranking

National Senior Ranking National Junior Ranking

State Affiliated

Current Club (if applicable) Current Manager (if applicable)

Associated Institute/Academy of sport

List major international and national sporting achievements in the past two years. (State results don’t need to be included.) Please summarise in dot point form commencing with most recent performances. Please note the award type to which achievement refers: Junior or Senior.

International

1. Award Type

2. Award Type

3. Award Type

4. Award Type

5. Award Type

National

1. Award Type

2. Award Type

3. Award Type

4. Award Type

5. Award Type

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Yes No

Yes No

Section 4 What is the Scholarship applicant’s development plan to progress in their chosen sport?

Section 5 Is the Scholarship applicant expected to relocate outside of Australia with their sport over the next 18 months?

If yes, please list where:

If yes, please list dates:

Section 6 How does the Scholarship applicant combine and balance schooling / work with their chosen sport?

Section 7 Special Considerations Please use this section to site other support information such as - remote/regional location; low socioeconomic status or unsupportive environment (family, community)

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Yes No

Section 8 How will the Scholarship applicant use this scholarship with respect to:

A) Mentoring Program

1. Outline ways in which having one-on-one mentoring from an Inducted Member of SAHOF will benefit the Scholarship applicant’s sporting career:

2. What are three things you want to learn from a Mentor?

1.

2.

3.

3. List three Members of SAHOF, outside of the Scholarship applicant’s sport that they would choose as a Mentor if they could (click on these links to view our Athlete Members and General Members):

1.

2.

3.

4. We strongly encourage you to submit a 45 second video featuring a bit about yourself, why you love your sport, and how the Scholarship and Mentor will benefit you. Video Details: Attachment?:

Link?: Link:

B) Scholarship Promotion: How will the Scholarship applicant use the SAHOF logo to promote the Program? (Ideas include reproducing on uniform/training gear/equipment/digital collateral/etc)

C) Digital Media Platforms: Please provide links and total likes/followers to date of the Scholarship Applicant’s social media profile and other web based media in which they use to promote themselves: (List only sport/athlete pages not personal):

Likes Followers

Followers Website

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Yes No

Yes No

D) Financial Grant SPORT ONLY(The Scholarship Grant can only be used for the purposes of supporting the athlete within the sporting environment rather than forpersonal living expenses such as rent etc.)

1. Please provide a detailed breakdown of the Scholarship applicant’s expected budget for 2019 in the below table:*In-kind includes; gym, medical, physiotherapy, rehabilitation, psychologist, travel, accommodation, uniforms, etc.

The Sport Australia Hall of FameScholarship & Mentoring Program 2019

Income Expenditure

Cash Amount In-kind Amount* Cash Amount

Australian Institute of Sport

Grant/Program/ Funding

Name:

$ $ Training Equipment

(Approximate total for 2019)

$

Other National Institute

Name:

Grant/Program/ Funding

Name:

$ $ Competition Equipment

(Approximate total for 2019)

$

State Institute / Academy

Name:

Grant/Program/ Funding

Name:

$ $ Coaching Fees

(Approximate total for 2019)

$

National Sporting Organisation

Grant/Program/ Funding

Name 1:

Name 2:

$ $ Sport Travel & Accommodation

(Approximate total for 2019)

$

State Sporting Organisation

Grant/Program/ Funding

Name:

$ $ Health Insurance

(Approximate total for 2019)

$

Sponsorship 1:

Company:

$ $ Other: $

Sponsorship 2:

Company:

$ $ Other: $

Other: $ $ Other: $

Total $ $ Total $

Net Position: (total income less expenditure) $

2. From the above table; please breakdown (up to the value of $5,000) the expenses that the grant will be used to cover.

NB: Training clothing will be capped at $500.

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Declaration

I declare that the information I have provided in this applications is accurate and true. I understand that if the information provided is found to be false, this application will immediately be considered as unsuccessful and may affect future applications for the SAHOF Scholarship and Mentoring Program.

Scholarship applicant’s signature and acknowledgement that the above information is true and correct.

Signature Date:

If a third party has completed this application, please provide your contact details and sign below to acknowledge the accuracy of the information.

Name

Relation

Organisation

Phone

Email

Signature Date:

Please download, complete and save the nomination form and then return the details below or print and return the completed nomination form to the details below. Bonnie ElliottOperations CoordinatorThe Sport Australia Hall of FamePO Box 173 East Melbourne, VIC 8002Email operations@sahof.org.auPhone 03 9510 2066

Should you have any further questions about your application, please contact Bonnie on 03 9510 2066.

The Sport Australia Hall of FameScholarship & Mentoring Program 2019

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