Ontario Curling Council Quest for Gold Athlete Assistance Program Application Form. Category: Training to Win 1 (23+ years old) (as of June 30, 2015)

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1 Ontario Curling Council Quest for Gold Athlete Assistance Program Application Form Category: Training to Win 1 (23+ years old) (as of June 30, 2015) 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. Two (2) full cards (one male, one female) may be awarded to athletes over the age of 30 if they should qualify Minimum Point Threshold: 10 Applicants must have a minimum of 7 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 Description of Point Allocation Available Canadian Team Ranking System (CTRS) CTRS Season Total : Team Name: Athlete = Position on Team: (Total points 4) x 2.0 A. Athlete CTRS Season (prior to Dec 9, 2015) Team Name: Position on Team: Total : Athlete = Total points 4 B. Mixed Doubles CTRS Importance Weighting: (A+B) X 2.0 Canadian Mixed Doubles Championship Team Members: World Mixed Doubles Championship Mixed Play downs Provincial Mixed Championships Adult Team Name: Position on Team: Canadian Mixed Championship (Adult only) World Mixed Championship (Adult only) Varsity Ontario College or University Provincials School Name: Position on Team: Canadian College or University Nationals Participant =1 Quarter finalist = 3 Semi finalist = 4 Runner up = 5 Winner = 6 Quarter finalist = 7 Semi finalist = 8 Runner up = 9 Winner = 10 Runner up = 1 Winner = 2 Semi final = 3 Runner up = 4 Winner = 5 Semi finalist = 6 Runner up = 7 Winner = 8 Semi final = 1 Runner up = 2 Winner = 3 Semi final = 4 Runner up = 5 Winner = 6 Planning scores determined by the Q4G committee See Selection Criteria for Details Seasonal Plan containing Competition Schedule with Up to two (2) points results to date Fitness Plan and results Up to two (2) points Total: 3

4 Tiebreakers Athlete Name: Description of Point Allocation ** Other International Event Competitions (not recognized by CTRS) ex. Yichun International Curling Championship 1. Event Name: Event Date: Team Name: Position on Team: 2. Event Name: Event Date: Team Name: Position on Team: Winner = 3 Runner-up = 2 Semi-finalist = 1 Athlete 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: 2. Course Name: 3. Course Name: 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: 4

5 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 5