Ontario Curling Council Quest for Gold Athlete Assistance Program Application Form. Category: Wheelchair Curling

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1 Ontario Curling Council Quest for Gold Athlete Assistance Program Application Form Category: Wheelchair Curling PLEASE READ the Quest for Gold Selection Criteria completely to ensure eligibility. Application Instructions: Please follow the instructions carefully. Incomplete or incorrect applications will not be scored. Applications must be from individuals, no team applications will be accepted Please complete the Application Form with the detailed requested, answer all questions. Team names and position on the teams must be included, if missing, no points will be awarded Only event results/rankings from the May 1, 2014-December 9, 2015 time period will be accepted Do not change the form, add to the form, etc Applications must be submitted by December 14, 2015 at 12:00 pm EST. Late applications will not be accepted, no exceptions. Do not fill in points totals Selection Committee will do that Sign and date the application Submission of false information will result in program ineligibility. Minimum Point Threshold: Applicants must have a minimum of 20 points to be eligible to apply Application Submission All required information must be submitted no later than December 14, 2015 at 12:00 pm EST. Applications may be mailed, couriered, faxed or ed. Submit to: Jennifer Ferris, Manager, Programs & Operations jennifer@ontcurl.com Address: 1400 Bayly St., Unit 10, Pickering, ON, L1W 3R2 Phone: , Fax: Jennifer Ferris Direct: An will be sent by 5:00 p.m. on December 14, 2014 confirming receipt. It is the athlete s responsibility to contact the Jennifer Ferris of the Ontario Curling Council (jennifer@ontcurl.com) if this is not received to be certain that the application has been successfully received by the deadline date. Applications that are sent directly to the Ministry of Tourism, Culture and Sport rather than to Ontario Curling Council will not be considered valid or to have been received by the Ontario Curling Council deadline.

2 Ontario Curling Council Quest for Gold Athlete Assistance Program Training to Win 1 (23+ years old) Application Form Name: Male: Female: Address: Street City Postal Code: Home Phone: Cell Phone: Date of Birth (DD/MM/YY): Age as of June 30, 2015: Member Association: NOCA OCA Club Represented: 9. Present Educational Status (i.e. School, university, college, full time, part time) 10. Coach Information Coach Name: NCCP#: Coach Phone: Coach Certification Level: How many years has coach worked with applicant? *Note Coaches must sign Coach Acknowledgement Form applications submitted without this form will be considered incomplete. 2

3 A. B. C Description of Point Allocation Points Available Athletes are to record finishes in all events played, but will only be able to count their top two (2) events NOCA or OCA Provincial Playdowns Team Name: Cathy Kerr Bonspiel* Team Name: Cape Code Bonspiel* Team Name: Winner = 10 Runner-up = 8 Semi-finalist = 6 Main Event Winner = 10 Main Event Runner-up = 8 2 nd Event Winner = 6 2 nd Event Runner-up = 5 3 rd Event Winner = 4 3 rd Event Runner-up = 3 4 th Event Winner = 2 4 th Event Runner-up = points per win Athlete Points D E Utica Wheelchair Bonspiel* Team Name: 2015 Ontario Parasport Championships* Team Name: Gold = 10 Silver = 8 Bronze = 6 Winner = 8 Runner-up =6 Top Two Events: + Winner = 15 Canadian National Championships Runner-Up = 13 Semi-Finalist = 12 Skill Based Testing Total Score Maximum of 48 points (See application form)* Planning scores determined by the Q4G committee See Selection Criteria for Details Seasonal Plan containing Up to two (2) points Competition Schedule with results to date Fitness Plan and results Up to two (2) points Total: 3

4 Quest for Gold Wheelchair Application Skill Based Testing Instructions athletes may complete all six drills at once or divide and complete in segments. Two attempts are allowed and recorded for each shot. Drills must be witnessed by a Certified Coach or Club official (Manager, President, etc ). Witness must not be related to athlete. ***This form must be included with the athlete s application. Athlete Name: _ Drill #1 Drill #2 Drill #3 Drill #4 Drill #5 Drill #6 Date Completed Attempt #1 Attempt #2 Total Grand Total (Record this number on the application form) Witness Name: Witness Title/NCCP #: Date: 4

5 Quest for Gold Wheelchair Application Skill Based Testing Drill #1 Zone 1 Hogline Zone 3 Centerline Draw In the Rings Clockwise As indicated in green boxes Zone 2 1 pt 2 pt Zone 3 4 pt Zone 4 3 pt Drill #2 Zone 1 Hogline Zone 3 Centerline Draw In the Rings Counterclockwise As indicated in green boxes, Zone 2 1 pt 2 pt Zone 3 4 pt Zone 4 3 pt 5

6 Drill #3 Hit Opposition Stone in 8 Foot Remove Opposition Stone from Play Shooter Remains in Rings Clockwise 4 Pts Remove Opposition Stone and Shooter remains in Rings 2 Pts Remove Opposition Stone and Shooter rolls out of Rings 1 Pt Move Opposition Stone Behind T line Drill #4 Hit Opposition Stone in 12 Foot Remove Opposition Stone from Play Shooter Remains in Rings Counterclockwise 4 Pts Remove Opposition Stone and Shooter Remains in Rings 2 Pts Remove Opposition Stone and Shooter Rolls Out of Rings 1 Pt Move Opposition Stone Behind T line 6

7 Drill #5 Zone 1 Hogline Zone 3 Draw Around Center Guard to 4 Foot In the Rings or Tight Guard Clockwise As indicated in green boxes Your Total Score: Max Score = 8 Zone 2 1 pt 3 pt Zone 3 4 pt Zone 4 2pt Drill #6 Hit Opposition Stone in 4 Foot Remove Opposition Stone from Play Shooter remains in Rings Counterclockwise 4 Pts Remove Opposition Stone and Shooter remains in Rings above T line 3 Pts Remove Opposition Stone and Shooter remains in Rings behind T line. 2 Pts Remove Opposition Stone and Shooter Rolls Out of Rings 1 Pt Move Opposition Stone Behind T line Your Total Score: Max Score = 8 7

8 Tiebreakers Athlete Name: Description of Point Allocation ** Other Integrated or wheelchair Competitions which athlete has competed in. 1. Event Name: Event Date: Team Name: 2. Event Name: Event Date: Team Name: Points Winner = 3 Runner-up = 2 Semi-finalist = 1 Athlete Points Training Camp or Talent Identification Camp Participation ie. La Releve, Curling Canada Wheelchair Development Camps, High Performance Camps 1. Camp Name: Camp Date: Was this camp invitational? Yes No 2. Camp Name: Camp Date: Was this camp invitational? Yes No Coach Training or Evaluation 1. Course Name: Course Date: 2. Course Name: Course Date: 3. Course Name: Course Date: 0.5 pts/day Club Coach: Youth 0.5 pt Club Coach 1 pt Competition Coach 2 pts Competition Development 3 pts Professional Development Events 0.5 pts Tiebreaker Total: 8

9 Application Signature By signing below I acknowledge that all of the above is true and that any false information provided will void the application. Signature: Date: Privacy Statement The Ontario Curling Council is gathering the information provided in this application for the sole purpose of determining potential recipients of the Quest for Gold Ontario Athlete Assistance Program. When you register/apply for this program, the Ontario Curling Council may use this information in the assessment, communication and award notification with such recipients and to the community at large. In addition, the Ontario Curling Council may be required to provide this information to the Government of Ontario to ensure compliance with their program requirements and in any review by other parties of those athletes that receive an Ontario Card designation. The Ontario Curling Council will not release this information to any third party or curling association without the express written consent of the registrant. Application Checklist Completed Application form for appropriate category signed and dated Coach Acknowledgement Form Annual Training Plan and Competition Schedule for Season with results to date Fitness Training Plan with Progressive Results Skill Based Testing Record Form 9