grant aid online2 distributed-1 mw
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8/2/2019 Grant Aid Online2 Distributed-1 Mw
1/2
ASANER Oct 2010
Please print off this page, complete the relevant information for the
applicant, and return with the grant application.
Name of club
swim21 accredited?Level ofaccreditation
Name of applicant
Address of applicant(including postcode)
Daytime phone number
Email address
Applicants ASA numberApplicants ASA Licencenumber
Course discipline Level
IOS venue of course
Start date of course End date of course
Name of Tutor Cost of course
Signed applicant Date
Address of club secretary(including postcode
Daytime phone number
Email address
Signed club secretary Date
If applicant is under 18 years of age then parent/guardian must countersign below
Signed (parent/guardian) Date
Date received
Decision
Amount of grant
Sent to office
ASA North East Grant Aid application form
All information is mandatory. This form will be returned to applicant if incomplete.Written signatures are not required please insert your name an e-version will constitute a signature.
The ASA North East Region will use your personal data for the purpose of your involvement in theASA NER Grant Aid Scheme. I understand that by submitting this form I am consenting to
receiving information about the ASA NER Grant Aid Scheme by post, email, SMS/MMS, online orhone unless stated otherwise.
Please note the guidanceinformation available online.
Complete this form both pages -and email to:
Billingham ASC
Yes Skill Development
Maria Whyborne
Leicester Way
Eaglescliffe
Stockton-on-Tees TS16 0LP
01642 659787
536397
Safeguarding Children
Northfield Sportsdrome
17th May 2011 17th May 2011
Joan Hope 35
M Whyborne 2nd July 2011
Tara
Middlesbrough Road
Guisborough TS14 8HY
Debbie Williams 2nd July 2011
mailto:[email protected]:[email protected]:[email protected] -
8/2/2019 Grant Aid Online2 Distributed-1 Mw
2/2
ASANER Oct 2010
Please complete the relevant information for the applicant, and returnwith the grant application
Ethnicity codes:
Pleaseas applicable
A White British B White Irish
C White Other D Asian Indian
E Asian Pakistani F Asian Bangladeshi
G Asian Other H Chinese
I Mixed White & Black Caribbean J Mixed White & Asian
K Mixed Other L Black Caribbean
M Black African N Black Other
O Other ethnic group
Disability codes:
Pleaseas applicable
00 No known disability 01 Dyslexia
02 Blind/are partially sighted 03 Deaf/have a hearing impairment
04Wheelchair user/have mobilitydifficulties
05 Personal care support
06 Mental health difficulties 07An unseen disability e.g.diabetes, epilepsy, asthma etc
08 Multiple disabilities 09 Information refused/not known
x
x