1. Sporting Details Which sport do you compete in? Which club(s) are you a member of/do you compete for?* 2. Personal Details Please enter your details First Name Surname Address 1 Address 2 Town County Post Code Date of Birth January February March April May June July August September October November December 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Student Number (if applicable) Are you a Prospective Student? Please choose Yes No Course of Study Commencement Date Clothing Size Email Address Contact Number 3. Achievements Please give details of your achievements at the various levels of competition with the most recent first, stating the year. Schools* Representative Honours* National/Provincial* International* Committee representation/coaching awards/volunteering experience* 4. Competition Please state number of games you have competed in the past year: (state highest level). Max 500 words Competition* 5. Any Additional Information Relevant to Application Additional* 6. Aims and objectives for forthcoming year Aims* 7. References: please give names of 2 referees (note these should not be relatives) Referee 1 Referee 1 Name* Referee 1 Address Referee 1 Status Referee 1 Email* Referee 1 Telephone* Referee 2 Referee 2 Name* Referee 2 Address Referee 2 Status Referee 2 Email* Referee 2 Telephone* Please note that as an Elite Athlete recipient your details will be forwarded to the Queen's Student Recruitment Team who may wish to meet you. Throughout the year, the Student Recruitment Team may then invite you to accompany them on a visit to your old school or other schools where you may be required to give a short presentation on your experience at Queen's and your involvement in an Academy. You may also be invited to provide profile information to be used in promotional material. By ticking this box and submitting this form I am agreeing to the terms and conditions.