Basketball Playing Record: (Please indicate teams and years in School, Club
and Representative Levels)
Southern Sports Academy
Prime Basketball Scholarship Program
Boys and Girls
Club: Born: 1997, 1998, 1999
(Aged 13, 14 or 15 in 2012)
Saturday 29th October 2011 (Phase One)
Sunday 30th October 2011 (Phase Two)
Bolton Park Stadium, Wagga Wagga
Trials commence 9.00am
Playing Goals for upcoming year:
By completing this application you have been selected to trial.
Parent / guardian: I give my child/ward
Permission to trial for selection to the Southern Sports Academy 2012 Basketball
Scholarship Program to be held at the Bolton Park Stadium, Wagga Wagga on
Saturday 29 October and Sunday 30 October (if required) 2011.
Signed: Date: / /
Please complete this form in full and return by Friday 14 October 2011.
2012 Basketball Scholarship Program Further information is available by contacting the Academy
Southern Sports Academy on phone 6931 8111 or email: email@example.com
PO Box 8545
NOTE: If an athlete is unable to attend the trial, they should lodge
For further information contact: Southern Sports Academy, this nomination with a letter clearly outlining reasons why an
on phone 02 6931 8111 or Email: firstname.lastname@example.org. exemption should be granted for inability to attend. The application
Applications are also available at: www.ssa-nsw.org.au will be considered prior to the trial and the athlete will be notified if
their exemption has been approved.
What Does The Southern Sports Academy Do? 2012
Southern Sports Academy athletes come together at least once a month to Basketball Scholarship Program
receive the best and most professional coaching available in the area. Our
coaching staff are the highest qualified and most experienced coaches available Nomination Form
in Southern NSW. They are passionate about working with and developing
talented young athletes from the area and continue to produce outstanding Surname: Given Name:
athletes, some of which have progressed to the highest level in their chosen
In addition to the quality coaching, all scholarship holders in the Academy are Postcode:
also exposed to a range of workshops from our specialist consultants including
workshops relating to Sports Psychology, Nutrition, Recovery, Core Strength as Email:
well as receiving Strength and Conditioning advice that is specific to their sport.
School Attended Year
The Southern Sports Academy also understands there is a great deal more to
being an outstanding athlete than what happens solely on the sporting field. To Phone: (Home) (Bus)
this end, the Academy provides professional tuition for its athletes on Personal
Development related issues. Topics that are covered include (but are not Parent’s / Guardians Name(s):
restricted to) Leadership Skills, Goal Setting, Expectations and Obligations of the
Professional Athlete, Responsible Use of Social Media, Time Management and Emergency Contact No. Medicare No.
Medications/Medical Conditions (eg. Asthma, Allergies etc):
All this adds up to the Southern Sports Academy leading the way in terms of
providing valuable development opportunities for junior athletes in the Southern ___________________________________
Declaration and Authority
I, Mr / Mrs / Ms hereby give
permission for to receive whatever
The Southern Sports Academy is holding selection trials for athletes wishing to medical attention is deemed necessary in the case of illness or accident. I also
gain a Basketball Scholarship in 2012. undertake to pay all associated costs (ie. Ambulance travel), medical fees and /
or the cost of drugs which may be incurred while my child / ward is in the care of
From the trial up to 16 athletes from the Southern Sports Academy region the Academy. This permission is given to the Basketball staff of the Southern
will be offered an Academy Basketball Scholarship. ports Academy.
Scholarships are not in the form of a monetary sum, but enable the athlete
to participate in Academy development programs at a greatly reduced rate. Player Profile
Supplying all player details is compulsory, do not leave blank
Southern Sports Academy spaces
2012 Basketball Scholarship Trials
Please arrive 20 minutes prior to the scheduled start, dressed in Basketball DOB: / / Height Weight
playing/training gear including mouth guard, and any personal strapping if
* Name of current club?
Please bring a basketball, water bottle and any medication (Asthma puffers, etc.)
* Preferred playing positions 1. 2.
clearly marked with your name if needed
* Are you of Aboriginal or Torres Strait Islander descent? YES / NO
** Persons arriving late will not be accepted **
*** Complete Details Over Page ***