SASI APPL - SASI Water Polo Scholarship

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					                           SASI Water Polo
                     Full Scholarship Application

Section 1                 Personal Details

Name

Title ____________ Given Names ________________________________ Family Name __________________

Age ____________ Date of Birth ______________ Time of Birth (if known)__________    Female       Male

Current Address _____________________________________________________________________________

____________________________________________________________ Postcode ______________________

Telephone _________________________________ Fax ____________________________________________

Mobile _________________________________ Email ______________________________________________


Parent’s Details


Father ______________________________________ Mother ________________________________________

Contact Address 1 ___________________________________________________________________________

____________________________________________________________ Postcode ______________________

Contact Address 2 (if different for second parent) ___________________________________________________

____________________________________________________________ Postcode ______________________

Telephone         F____________________________________ M__________________________________

Mobile            F ____________________________________ M _________________________________

Email             F _________________________________________________________________________

                  M _________________________________________________________________________


Section 2                  Education and Employment

Current Year at school __________________________ Year of finishing school __________________________


Tertiary Education

    Full time                 Part time                External                    Deferred

Institution __________________________________________________________________________________

Year / stage ________________________________________________________________________________

Employment

    Full time                 Part time
 Section 3            Sport Details


 Representation

 What representative (State or Australian) teams have you been part of in any sport?

                                                           AGE
SPORT                       COMPETITION                                  RESULT          COMMENT
                                                          GROUP




 Goals

 What are your Sporting Goals? _________________________________________________________________
 __________________________________________________________________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________


 What are you Life Goals? ______________________________________________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________


 Water Polo History


 Started playing Water Polo _____________________________________________________________________

 Handedness ________________________________ Playing position __________________________________


 State Team Representation (Years and Result) _____________________________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________


 Australian Team Representation (Age Group and Years) _____________________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________


 Water Polo Awards / Honours (Age Group, Year and name of Award) ___________________________________
 ___________________________________________________________________________________________
 ___________________________________________________________________________________________
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Fitness


Please provide as many of the following details as possible.


400m swim time                Current _______________________ Date of Test ___________________________
                              Personal Best __________________ Date of Test __________________________


100m swim time                Current _______________________ Date of Test ___________________________
                              Personal Best __________________ Date of Test __________________________


Legwork                       Type of Test ________________________________________________________
                              Current _______________________ Date of Test ___________________________
                              Personal Best __________________ Date of Test __________________________


Skinfold Assessment           Current _______________________ Date of Test ___________________________
                              Personal Best __________________ Date of Test __________________________




Letter of Application


If you were granted a SASI Water Polo Full Scholarship, what benefits would you bring to the program? [Please
continue on a separate A4 page if there is not enough room below].
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Section 4                     Declarations


Injury / Illness disclosure


List all illnesses and injuries that have affected your training in the last 12 months, whether they were sustained
during that time or are on-going concerns.


                                             How long
      Illness / Injury                                           Medical Practitioner                      Contact Details
                                             injured?




SASI Squad Selection Policy


      I have read and understand the SASI Squad selection policy attached.


Declaration and Signature


I wish to be considered for entry to the South Australian Sport Institute Water Polo Program, and I declare
that all information submitted on this application form is correct and complete. I understand that the
South Australian Sport Institute reserves the right to vary or reverse any decision regarding omission
made on the basis of incorrect or incomplete information.


Signature of applicant ______________________________________________________ Date ______________


If the applicant is under 18 years of age, the parent, guardian or custodian who is the first legal point of
contact must sign.


Name _____________________________________________________________________________________

Relationship to Applicant ______________________________________________________________________

Address (if different to the information given earlier in this application) ___________________________________

__________________________________________________________________ Postcode ________________

Telephone _________________________________ Fax ____________________________________________

Mobile _________________________________ Email ______________________________________________

Signed ____________________________________________________________ Date ____________________


                                                                                                                      4
SQUAD SELECTION POLICY
1.    OBJECTIVES
     1.1 The objectives of the South Australian Sports Institute (SASI) Sportsplan Squad
        programs are:


      To identify talented athletes with the perceived potential to progress to the National
        Squad / Team level and to represent Australia at Junior and / or Senior level.
      To develop and support identified athletes in all areas that are required for elite
        performance
      To prepare athletes adequately and appropriately for future consideration as national
        team athletes
      Continue to maintain or increase the number of SA athletes in National Teams


2.    SELECTIONS
     2.1 Selections for SASI Sportsplan Squad programs will be conducted in consultation with
        State and National Sporting Organisations, and endorsed by the SASI Joint
        Management Committee (JMC).


     2.2 Selections for SASI Sportsplan Squad programs will be determined by a Selection
        Panel, which must include the SASI Head Coach.


     2.3 Sport specific selection criteria will be developed by the SASI Head Coach and the
        appointed Selection Panel, and will take into account any national criteria as part of the
        National High Performance Pathway.


     2.4 Scholarships can be offered as full or associate and will, as a principle, cover a 12
        month period. Shorter periods may be offered (eg. 1 – 3 month trial). Reviews may be
        conducted by the Selection Panel and SASI reserve the right to add or delete athletes
        to/from a scholarship squad at any time.


3.    ATHLETE OBLIGATIONS
     3.1 All athletes who have been selected in the SASI Sportsplan Squad program must:


    Have the intention to compete and/or be involved in active training (including injury
     recovery and rehabilitation)
    Abide by the terms and conditions as outlined in the SASI Athlete Agreement or other
     SASI policies
                                                                                                 5
    Have met the sport specific selection criteria, or selected as a developing potential elite
     athlete as determined by the appointed Selection Panel


4.     OTHER CONSIDERATIONS
     4.1 Achieving the nominated selection criteria does not automatically qualify the athlete for
        SASI Sportsplan Squad selection. Other factors that may be taken into consideration
        when determining final selections are:


    Whether the athlete has been charged with and/or convicted of a criminal offence
    Whether the athlete has previously breached their Athlete Agreement or other SASI
     policies, as outlined in the SASI Athlete Agreement and the SASI Behaviour and Discipline
     Policy
    Whether the athlete has previously behaved in a manner that has brought or has the
     capacity to bring SASI into disrepute
    Where it has been clearly demonstrated, based on previous behaviour or information, that
     the athlete has the capacity to bring SASI into disrepute
    Where the Selection Panel determines that, notwithstanding achievement of the selection
     criteria, the athlete does not have the potential to progress to Australian representation at
     Junior and / or Senior level.




5.     QUERIES ON SELECTION
     5.1 The Manager, Sportsplan, or SASI Head Coach, are the only officers authorised by
        SASI to respond to any questions concerning the athletes selected for SASI Sportsplan
        Squads, in accordance with this Selection policy and the sport specific selection policy


All questions concerning any aspect of selection must be in writing and addressed to the

Manager, Sportsplan, or the SASI Head Coach, for consideration by the Selection Panel.




Please send this completed document to:

Eddie Denis
SASI
27 Valetta Road, Kidman Park, 5025

or

scan and email to: denis.eddie@saugov.sa.gov.au




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