Ministry of Tourism, Culture and Sport quest for gold 2016-2017
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- Athlete Provincial (PSO) / Multi (MSO) or National Sport Organization (NSO) Relationship
- Coaching Data
- Additional Information
- Competition Information
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Awards History | |||||||||||||||||
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Do you receive SPORT CANADA Athlete Assistance Program funding (select one) No C1 SR1 SR DEV | |||||||||||||||||
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If you do receive Sport Canada Athlete Assistance Program funding, how many months per year are you funded? 12 11 10 9 8 7 6 5 4 3 2 1
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Are you currently receiving services from the Canadian Sport Institute Ontario? Yes No If No, are you currently aware of the services offered to you by the Canadian Sport Institute Ontario? Yes No | |||||||||||||||||
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Athlete Provincial (PSO) / Multi (MSO) or National Sport Organization (NSO) Relationship | |||||||||||||||||
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Are you a member in good standing with your PSO/MSO/NSO? Yes No | |||||||||||||||||
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Have you signed an Athlete Agreement with your PSO/MSO/NSO? Yes No | |||||||||||||||||
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Are you currently a registered member of your PSO/MSO/NSO? Yes No | |||||||||||||||||
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Do you compete on behalf of Ontario at National Championships? Yes No | |||||||||||||||||
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Have you competed on behalf of any other province or country within the past two years? Yes No If yes, which one? | |||||||||||||||||
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Have you previously been carded by the Quest for Gold program? Yes No | |||||||||||||||||
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If Yes, which years have you received a Quest for Gold ‘Ontario Card’? 2015/2016 2014/2015 2013/2014 2012/2013 2011/2012 2010/2011 2009/2010 2008/2009 2007/2008 2006/2007 2005/2006 | |||||||||||||||||
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If Yes, which years have you received a Quest for Gold ‘Canada Card’? 2015/2016 2014/2015 2013/2014 2012/2013 2011/2012 2010/2011 2009/2010 2008/2009 2007/2008 2006/2007 2005/2006 | |||||||||||||||||
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Which years have you received funding from Sport Canada? (select all that apply) 2015/2016 2014/2015 2013/2014 2012/2013 2011/2012 2010/2011 2009/2010 2008/2009 2007/2008 2006/2007 2005/2006 2004/2005 2003/2004 2002/2003 2001/2002 2000/2001 1999/2000 1998/1999 1997/1998
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Are you currently, or have you in the previous two years, received funding from any other Athlete Assistance programs, other than Sport Canada’s Athlete Assistance Program? Yes No | |||||||||||||||||
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If Yes, which province/country?
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If Yes, provide details
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Coaching Data | |||||||||||||||||
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Name of Coach | |||||||||||||||||
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Last Name
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First Name
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Middle Initial
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Business Mailing Address | |||||||||||||||||
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Unit No.
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Street No.
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Street Name
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PO Box
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City/Town
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Province
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Postal Code
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Business Telephone No. (incl. area code)
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E-Mail Address
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Coaching certification number and NCCP level or equivalent (please specify)
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Additional Information | |||||||||||||||||
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Education (Only answer the section that applies to you) | |||||||||||||||||
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Are you currently enrolled in an educational institution? Yes, I am enrolled FULL TIME No, I am not currently enrolled | |||||||||||||||||
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What is your current highest level of education? University College Trade School High School Jr. High School Elementary | |||||||||||||||||
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If you are currently enrolled in school, where is it located? N/A
Province, list USA
Name of college/university | |||||||||||||||||
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What is your current Level of Competition? Provincial National International | |||||||||||||||||
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If applicable, please list your provincial, national, or international ranking
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Have you been or are you a member of your sport’s junior national team? (select all that apply) No 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 | |||||||||||||||||
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Have you been identified by your National Sport Organization as a next generation National Team Athlete? Yes
No N/A
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Have you been or are you a member of your sport’s senior national team? (select all that apply) No 2016 2015 2014 2013 2012 2011 2010 2009 2008 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 | |||||||||||||||||
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Competition Information | |||||||||||||||||
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Have you competed at the Olympics/Paralympics? (select all that apply) Rio 2016 Sochi 2014 London (2012) Vancouver (2010) Beijing (2008) Turin (2006) Athens (2004) Salt Lake City (2002) Sydney (2000) Nagano (1998) Atlanta (1996) Lillehammer (1994) Barcelona (1992) Albertville (1992) Seoul (1988) Calgary (1988) Los Angeles (1984) Sarajevo (1984) | |||||||||||||||||
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Have you competed at the Pan American Games or Para Pan American Games? (select all that apply) Toronto – Canada (2016) Guadalajara – Mexico (2011) Rio de Janeiro – Brazil (2007) Santo Domingo – Dominican Republic (2003) Winnipeg – Canada (1999) Mar del Plata – Argentina (1995)
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Have you competed at the Commonwealth Games? (select all that apply) Glasgow – Scotland (2014) New Delhi – India (2010) Melbourne – Australia (2006) Manchester – England (2002) Kuala Lumpur – Malaysia (1998) Victoria – Canada (1994) Auckland – New Zealand (1990) Edinburgh – Scotland (1986)
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Have you competed at the Canada Games? (select all that apply) Prince George BC (2016) Sherbrook QC (2013) Halifax NS (2011) Corner Brook NF (1999) Charlottetown/Summerside PEI (2009) Brandon MB (1997) Whitehorse YK (2007)) Grande Prairie AB (1995) Regina SK (2005 Kamloops BC (1993) Bathurst-Campbellton NB (2003) Charlottetown PEI (1991 London ON (2001) Saskatoon SK (1989)
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Have you competed at an Ontario Games or an Ontario Parasport Games? (select all that apply) Mississauga – Ontario Summer Games (2016) Northumberland – Ontario Parasport Games (2014) Windsor– Ontario Summer Games (2014) Toronto – Ontario Summer Games (2012) Bracebridge – Ontario Winter Games (2014) Toronto – Ontario Summer Games (2012) Kingston – Ontario Parasport Games (2013) Collingwood – Ontario Winter Games (2012) Huntsville – Ontario Winter Paralympic Championships (2006) Huntsville – Ontario Parasport Winter Games (2012) Ottawa – Ontario Summer Games (2006) Sarnia-Lambton – Ontario Parasport Summer Games (2011) Collingwood – Ontario Winter Games (2006) Sudbury – Ontario Summer Games (2010) Essex – Ontario Summer Paralympic Championships (2005) Muskoka – Ontario Winter Games (2010) Etobicoke – Ontario Paralympic Summer Championships (2004) Kingston – Ontario Parasport Winter Games (2010) London – Ontario Summer Games (2004) Woodstock – Ontario Parasport Summer Games (2009) London – Barrie/Collingwood – Ontario Winter Games (2004) Ottawa – Ontario Summer Games (2008) Sarnia – Ontario Paralympic Summer Championships (2003) Scarborough – Ontario Parasport Summer Games (2008) Kitchener/Waterloo – Ontario Summer Games (2002) Collingwood – Ontario Winter Games (2008) Guelph – Barrie/Collingwood – Ontario Winter Games (2002) Collingwood – Ontario Winter Paralympic Championships (2008) Durham Region – Ontario Summer Games (2000) Sarnia – Ontario Paralympic Summer Championships (2007) Sault Ste. Marie – Ontario Winter Games (2000) London – Ontario Paralympic Summer Championships (2006) Guelph – Ontario Summer Games (1998)
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