Ministry of Tourism, Culture and Sport quest for gold 2016-2017



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Awards History

Do you receive SPORT CANADA Athlete Assistance Program funding (select one)

 No  C1  SR1  SR  DEV



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


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




Athlete Provincial (PSO) / Multi (MSO) or National Sport Organization (NSO) Relationship

Are you a member in good standing with your PSO/MSO/NSO?

 Yes  No



Have you signed an Athlete Agreement with your PSO/MSO/NSO?

 Yes  No



Are you currently a registered member of your PSO/MSO/NSO?

 Yes  No



Do you compete on behalf of Ontario at National Championships?

 Yes  No



Have you competed on behalf of any other province or country within the past two years?

 Yes  No If yes, which one?      



Have you previously been carded by the Quest for Gold program?

 Yes  No



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



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



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


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



If Yes, which province/country?

     


If Yes, provide details

     


Coaching Data

Name of Coach

Last Name

     


First Name

     


Middle Initial

   


Business Mailing Address

Unit No.

     


Street No.

     


Street Name

     


PO Box

     


City/Town

     


Province

  


Postal Code

     


Business Telephone No. (incl. area code)

     


E-Mail Address

     


Coaching certification number and NCCP level or equivalent (please specify)

     


Additional Information




Education (Only answer the section that applies to you)

Are you currently enrolled in an educational institution?

 Yes, I am enrolled FULL TIME

 Yes, I am enrolled PART TIME

 No, I am not currently enrolled



What is your current highest level of education?

 University  College  Trade School  High School  Jr. High School  Elementary



If you are currently enrolled in school, where is it located?

 N/A


 Province, list      

 USA


Name of college/university      

What is your current Level of Competition?

 Provincial  National  International



If applicable, please list your provincial, national, or international ranking

     


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



Have you been identified by your National Sport Organization as a next generation National Team Athlete?

 Yes


 No

 N/A


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



Competition Information

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)



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)


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)


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)


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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