Deaf and Hard of Hearing Athlete Assistance Grant Application Form

APPLICATION DEADLINES

Athlete:
The athlete is required to submit the completed application to their Provincial Sport Organization (PSO) or Multi-Sport Organization (MSO) for endorsement by March 22 and/or September 22 annually. If an athlete is not currently connected to a PSO/MSO, the athlete can work together with the Sask Sport Adaptive Sport Coordinator and/or Saskatchewan Deaf & Hard of Hearing Services (SDHHS) to create the necessary connection.

PSO/MSO:
The PSO/MSO must review, sign, and submit the application to the Sask Lotteries Trust Fund (SLTF) by April 1 and/or October 1 annually.

ATHLETE INFORMATION

(To be completed by the athlete)

Name*

First Last

Birthday*

Month

Day

Year

Name of sport/discipline*

Address*

Mailing Address City/Town Province Postal Code

Phone*

Athlete Email*

Voluntary Self-Identification

Sask Sport is dedicated to supporting sport participation opportunities for all Saskatchewan people. Providing a response to the following statement below is voluntary. Information provided may be used for communications with members, or participants, within our organization and/or statistical purposes in a compiled format (ONLY). Personal information will not be used or shared outside of our organization.

Self-Identification

Female
Male
Prefer to Self-Describe

Prefer to Self-Describe as

ATHLETE ELIGIBILITY

(To be completed by the athlete)

I am a member in good standing with the Provincial Sport Organization or Multi-Sport Organization?*

Yes
No

I am training in Saskatchewan?*

Yes
No

If no, I am applying based on one of the exceptions:*

I am training out of province as part of a formal National Sport Organization (NSO) or Canadian Deaf Sport Association sanctioned training program.
I cannot receive the required level of training in Saskatchewan and as a result have relocated out of the province (Ex. due to lack of facilities, coaching, competition, national team requirements).
I am attending an out-of-province university or college.
Other special reasons that require me to be out of the province.

I am a product of the Saskatchewan sport system because a significant and/or relevant portion of my sport development occurred while a primary resident of Saskatchewan?*

Yes
No

My coach is a qualified coach/instructor?*

Yes
No

Please provide the name of your coach/instructor:*

ATHLETIC PERFORMANCE

(To be completed by the athlete)

Please indicate the level of competitions you have competed at:*

(check all that apply)

Local
Provincial
Regional (Ex. Westerns)
National
International

How often do you train in your sport?

Number of hours per week:*

Number of weeks per year:*

Comments:

GRANT REQUEST

(To be completed by the athlete)

What is the grant amount being requested?*

(maximum $2,000)

Please enter a number from 1 to 2000.

I am requesting athlete assistance for the following costs associated with:

(check all that apply)

Attending competitions (Ex. entry fees, on-continent travel costs, hotel accommodations).

Please indicate the competition(s), location(s) and date(s):*

Competition	Location	Dates (dd,mm,yyyy)

Use the + to add information

attending training camps

Attending training camps (Ex. entry fees, on continent travel costs, hotel accommodations).

Please indicate the training camp(s), location(s) and date(s):*

Training camp	Location	Dates (dd,mm,yyyy)

Use the + to add information

training

Training (Ex. coaching expenses, sport science, facility rental fees, other athlete services).

Please indicate the type(s) of training, location and dates:*

Training type	Location	Dates (dd,mm,yyyy)

Use the + to add information

Assistance for sport participation

Assistance for sport participation (Ex. sign language interpreters, assistive technology, etc.)

Other

Other

Please describe:*

PROJECTED EXPENSES

(To be completed by the athlete)

Please Note: Financial documentation (receipts) must be provided at the time of the follow-up report. Please refer to the Follow-up Requirements section of the guidelines for acceptable forms of financial documentation.

Competition(s)

Competition(s)	Amount

Use the + to add information

Training Camp(s)

Training Camp(s)	Amount

Use the + to add information

Training

Training	Amount

Use the + to add information

Sport Participation

Sport Participation	Amount

Use the + to add information

TOTAL PROJECTED EXPENSES

ATHLETE APPLICATION CHECKLIST

Before sending the application to your PSO/MSO, we recommend you complete the following checklist to ensure your application is ready for submission.

I have read the Deaf and Hard of Hearing Athlete Assistance Grant Guidelines.
The application is being submitted prior to the start date of my competitions, camps, training, etc.
I have been in contact with my PSO/MSO regarding this application.
The application is complete, signed and dated.

ATHLETE DECLARATION AND CONSENT

consent 1*

I acknowledge that if this application is approved, I will be required to enter into an agreement with the Provincial Sport Organization/Multi-Sport Organization which will detail the terms and conditions of the grant.

consent 1*

I hereby agree that the terms and conditions outlined in the guidelines will be adhered to and the information presented in this application is correct and true.

Name of athlete or parent*

(Parent if athlete’s age is less than 18 years)

Date*

(dd/mm/yyyy)

After the athlete/parent has completed the application form, please send the link to the PSO/MSO for their endorsement by clicking on the Save and send link to PSO/MSO at the bottom of the form. The PSO/MSO will then review and choose to support the application form and submit it to Sask Sport.

Do not submit the application form. The PSO/MSO will submit the application after they add their endorsement.

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Celebrating Sport

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Deaf and Hard of Hearing Athlete Assistance Grant Application Form

APPLICATION DEADLINES

ATHLETE INFORMATION

ATHLETE ELIGIBILITY

ATHLETIC PERFORMANCE

GRANT REQUEST

PROJECTED EXPENSES

ATHLETE APPLICATION CHECKLIST

ATHLETE DECLARATION AND CONSENT

ORGANIZATION INFORMATION

PSO/MSO DECLARATION AND CONSENT